In the second week of medical school at the University of Ottawa, after students have barely read their syllabi and bought their books, they get a crash course in social media. In class, they discuss the platforms they’re using—Snapchat, Instagram et al.—and start a debate about how physicians should, or perhaps shouldn’t, use them on the job. “It’s only an hour,” says U of O anatomy professor Dr. Alireza Jalali, “but I think it’s a good start.”

In the digitally conservative world of Canadian medicine, “only an hour” is practically revolutionary. Seventy-seven per cent of Canadian doctors don’t use social media professionally, according to the 2014 National Physician Survey. Facebook, Twitter and the like, the thinking goes, are more trouble than they’re worth, pose a risk to the confidentiality of the patient-doctor relationship, and could compromise quality of care.

Not so to Jalali, who got into social media long before any regulatory body did. When he switched from practising sports medicine to teaching 10 years ago, he took the pulse of his students’ social media use and realized they were all on Facebook, talking with one another. So, he set up Facebook groups to communicate with his classes. Other doctors started to notice. “Slowly,” he says, “physicians came to me and told me they were interested.”

The Canadian Medical Association set out its guidelines on the topic in 2011 and, last August, installed its new Twitter-loving, Facebook-using president, Dr. Chris Simpson. “Twitter is a fantastic way to bring medical literacy to the general public,” he says. Physicians can tackle misinformation, such as that of the digitally savvy anti-vaccination movement, he adds, by tweeting links to studies.

Simpson thinks reluctant doctors fear that patients will use social media to contact them about medical problems. But, he says, new media don’t nullify old principles. “It becomes quite simple if physicians just think about meticulously protecting the privacy of their patients,” he says. Facebook friendships and googling patients almost always “exceed that boundary because of the potential for a breach of privacy.” (Not that physicians can’t have Facebook; Simpson has both personal and professional profiles.)

Millennials account for about a quarter of current CMA members; in 10 years, they’ll comprise half. Jalali sees the looming change every day in the form of his students, who use pseudonyms on Facebook and often worry about whether employers will google them. He thinks his students might be overestimating practising physicians’ online expertise. As proof, he mentions, with a laugh, the doctors who still complain to him, “ ‘I got on Facebook and I’m getting all these friend requests.’ That’s the whole point.”

In April 2009, ambulance-response times in the small southern Albertan town of Nanton seemed to double overnight. The town—like the rest of the province—had handed EMS responsibilities over to the newly formed Alberta Health Services (AHS) and, whereas ambulances used to arrive within 10 minutes, they suddenly took 20 or more. In some cases, they wouldn’t come at all.

Neil Wilson, the local reeve, brought the issue to Alberta’s health minister. Nothing changed. “We saw the minister at least twice a year for three years,” Wilson explains. “We thought, ‘We’re not getting anywhere with this,’ so we stepped up to the plate.” The local municipal district, Willow Creek, bought three ambulances and staffed them with trained volunteers. Response times dipped back down to pre-2009 levels. In late January, when three vehicles collided on a southern stretch of Highway 2, Nanton’s EMS arrived in six minutes. AHS took 26.

Nanton’s solution may be unique, but its situation isn’t. Last month, a group of anonymous Alberta medics began using the handle @StatusCodeRed to tweet records of lengthy response times, and instances of Code Red—that is, when no ambulances are available in a certain area—that often spanned entire city regions (including Calgary and Edmonton) and lasted several hours. For a time on Jan. 28, according to one tweet, there wasn’t a single ambulance available between Calgary and Lethbridge, a 200-km stretch. “I think AHS realizes,” Wilson says, “that we in the smaller communities are on the verge of revolution if they don’t do something pretty soon.”

George Porter, a paramedic who has worked in southern Alberta for more than 40 years, has experienced the problems first-hand. Over the past five years, he’s responded to multiple critical emergency calls that took up to an hour to reach. The cycle became familiar: Hospitals, which no longer had to foot the bill for ambulance transfers once AHS was introduced, began calling teams such as Porter’s to ferry rural patients into the city, although they were often healthy enough to take a taxi, a much cheaper option.

“You can’t blame them,” he says. “It’s so easy for a hospital to phone some number and get an ambulance to take a patient wherever they need to.” Then the team would get caught in traffic and end up waiting hours to off-load the patient at an overcrowded hospital. In the meantime, other ambulances—if they weren’t tied up in the same process—would change positions to cover the hole left in the first team’s absence, stretching coverage thin. Porter began to voice his concerns, but the problems persisted. Eventually, he gave up his full-time position; he now works on call. “I did everything I could, but nothing changed,” he says. “Carrying on there didn’t feel right.”

Darren Sandbeck, the AHS’s chief paramedic, says stories like Porter’s—and those shared anonymously on social media—are troubling, but are exceptions to the rule. AHS records show that 90 per cent of response times province-wide are under 12 minutes (in line with other provinces). To reduce the response times of the remaining 10 per cent, AHS is introducing non-ambulance transport vehicles and piloting “rapid transfer units”—multi-bed overflow rooms in a pair of Edmonton hospitals that have shown signs of early success. In March, Sandbeck will begin a tour of the province to “engage front-line staff in a conversation that will help us to hear their concerns and ideas for improving the system.”

Alberta’s problems, however, are hardly exclusive, says Chris Hood, president of the Ottawa-based Paramedic Association of Canada. “Across the country, we see extraordinary stories where people are experiencing long wait times . . . and paramedics waiting to off-load patients from their cots because there’s no available bed for them in the hospital,” he says.“These issues are not specific to EMS; they’re specific to health care.” He says Alberta’s circumstances are particularly severe, because the province is still tackling the transition (even five years on) to a provincial system, much as New Brunswick did in 2007, when it amalgamated 52 separate ambulance services. But the province is nonetheless an example of a national ailment—an underfunded and overburdened system—and “the people suffering are the patients.”

But Porter, the veteran paramedic, is worried his province will see more suffering before it makes any real changes. “It’s like a dangerous intersection,” he says. “The police, the firefighters, the medics, the residents all complain. They say they’ll send it to committee, that there’s no money in the budget. Then somebody’s kid gets killed and, within hours, there’s a crosswalks, lights, a crossing guard, everything. Why do we have to wait until that happens?”

A South African man with Parkinson’s disease, a degenerative disorder that often leaves its sufferers immobile, walks his symptoms into submission. A Broadway singer, silenced for 30 years by multiple sclerosis, recovers his voice. And in California, a psychiatrist and pain specialist rids himself of 13 years of chronic pain within a year, without drugs or surgery, through his brain’s own efforts. Those individuals, and thousands like them, achieved those results, writes Norman Doidge, a Toronto psychiatrist and author of The Brain’s Way of Healing, precisely because the human brain is a generalist par excellence. The prevailing 20th-century view was that it was too specialized for its own good—a fixed machine made up of discrete parts that can break down, never to function again. That concept no longer stands up to scrutiny.

The brain is actually a supple, malleable organ, as ready to unlearn as it is to learn, capable of transforming vicious circles into virtuous circles, of resetting and repairing its internal communications. Far more than once dreamed possible, the brain can—if not always cure—heal itself.

Doidge wrote about the brain’s remarkable ability to recalibrate itself—what doctors call neuroplasticity—in his 2007 bestseller The Brain That Changes Itself. His new book recounts an astounding array of radical improvements in brain problems long thought irreversible. There are newly effective therapies, leading to improvement in, and sometimes even complete cures, for conditions ranging from stroke to traumatic brain injuries, learning disorders and missing brain parts. Even Parkinson’s and MS symptoms can be improved in new ways. “Like Marshall McLuhan said, the future is already here,” says Doidge in an interview. “The early neuroplasticians had to battle to get their findings accepted but now the field is not remotely controversial. I’m no longer talking about ‘promising’ developments down the road, but therapies that are here now. Patients and their caregivers just have to know who is doing things they thought impossible.”

And, crucially, to work hard at their own care. “We have been habituated to a way of thinking,” notes Doidge, which derives from what he calls the military metaphor of medicine, “the idea that the patient is merely the passive battleground where the two antagonists, the doctor and the disease, fight it out. The patient’s job is to endure until the doctor comes up with something, or, these days, to become involved in a fundraising event that will send money to researchers so they or the drug companies can come up with the answer.” But the plastic brain, capable of so much, still needs the help of mind and body to realize its possibilities.

Consider Dr. Michael Moskowitz, who knows pain both professionally and intimately. The co-operator of Bay Area Medical Associates in Sausalito, Calif., Moskowitz is a star in the treatment of pain, the man who sets the exams in pain medicine for aspiring American doctors. His clinic treats intractable cases, patients who have tried everything for their agony—all known drugs, nerve blocks, acupuncture—without result. “We are where people come to die with their pain,” he told Doidge. By 2007, 13 years after a waterskiing accident, it looked like Moskowitz would be one of them. The acute pain from his neck injury had morphed into permanent, and growing, chronic pain.

It did so via the same mechanisms that create that transformation in anyone. “Chronic pain is plasticity gone wild,” Doidge says. The injury to Moskowitz’s neck had also affected his body’s pain system, specifically the neurons in the brain associated with the neck area, causing them to fire repeated false alarms long after the neck had healed. What happened next illustrates core laws of neuroplasticity. Neurons that fire together, wire together: the more Moskowitz’s pain signals flared, the better and quicker they became at it. Use it or lose it: the fight for brain territory is competitive. The more Moskowitz favoured his neck because of the pain, the less the neurons involved with it had to do, and the more vulnerable they become to hijacking by nearby areas, including the pain sensors now working overtime. Moskowitz was caught in a vicious circle. His pain, 3/10 on the standard scale at the best of times, and spiking frequently to 8/10, was only getting worse. “Plasticity is a blessing when you’re listening to classical music and developing an appreciation for it,” Doidge wryly notes, “but it’s a curse when you are reinforcing pain.”

As his quality of life inexorably eroded, Moskowitz sat down to read 15,000 pages of cutting-edge neurological research, seeking a way to make plasticity work for him. Moskowitz concentrated on two areas of the brain among the dozen that do at least some pain processing, the posterior cingulate and the posterior parietal lobe, areas whose primary purpose is to deal with visual information.

He knew already that when a brain area is processing pain it uses about five per cent of the neurons in the area, but the reinforcement involved in chronic pain means about 15 to 20 per cent of the neurons become involved. By concentrating on an image of his brain—an image in which it changed from being lit up by pain activity to being calm and pain-free—Moskowitz thought he could quiet the original pain receptors and force the hijacked neurons back to their day jobs as visual processors.

It required relentless dedication at first, a conscious response to every twinge. In three weeks, Moskowitz thought he detected slight improvement, enough to spur him on; by six weeks the pain that had spread to his back was gone; within a year he was almost always pain-free everywhere. He had turned the vicious circle virtuous. “Relentlessness was the most important factor, absolutely,” Doidge agrees. “As a psychiatrist, I know that if you reframe a symptom attack as an opportunity, if instead of becoming crestfallen and pulling back, you treat every pain, anxiety or inhibition—reframe it as your moment—that’s the route to altering that circuitry. That’s what Moskowitz did. He didn’t let a single twinge of pain go by.”

Intense dedication is a hallmark of those who, all on their own, accomplish large-scale change in their brains. John Pepper, a South African now in his late seventies, was diagnosed in his thirties with the incurable, chronic, progressive neurodegenerative disease known as Parkinson’s. By all odds he should be immobile, if not dead, by now, but Pepper has fought his symptoms to a standstill by vigorous exercise carried out with ferocious determination and conscientious attention to detail. “Even as his unconscious ability to walk unravelled,” Doidge explains, “Pepper realized that if he analyzed how he walked and used his conscious mind to guide him, he could still do it. So he used a different part of his brain, the frontal lobes, and—like a child learning to walk—thought himself into efficient walking.”

Pepper’s case has fascinated everyone who has encountered it, partly because of his admirable bloody-mindedness, and partly for the way it demonstrates the importance, in recalibrating brain activity, of walking, the king of exercise. “It’s our evolutionary history at work,” Doidge argues. “When do animals do a lot a walking? When the environment they are in is being swarmed by predators or falls short of food. Moving to a new territory means entering a place where they have to do a lot of learning. When the brain takes note of a lot of walking, it and the body together secrete growth factors which put the brain into a super-plastic state, primed to learn.”

People with Parkinson’s have six times the dementia rate of those who do not, and Pepper is reaching what are the danger years for anyone, yet his mind is sharp. That, together with his mode of exercise and the first-the-right-heel-then-the-left-knee precision with which he pursues it, raise a question about Alzheimer’s, a disease where both exercise and conscientiousness are proven factors in delaying onset. Is Alzheimer’s a disease of plasticity, or rather of its absence? Doidge is cautious in response. “There are so many ways of looking at Alzheimer’s. Most researchers analyze it chemically, because of the proteins involved, in hopes of finding alleviating drugs, but to look at Alzheimer’s that way is to put it under the microscope at very high power—it is more holistic to think of an Alzheimer’s brain as one that is losing plasticity.”

Whether walking battles the onset of dementia through its link to plasticity or by its more general health benefits, it’s one of the most potent anti-dementia forces known. “Now we have the Cardiff study looking at the British men over 30 years and it shows that if you did five things, including walking at least three kilometres a day,” Doidge says, “the risk of dementia falls a staggering 60 per cent. If any medication did that, it would be the most talked-about drug in history.”

Not that drugs have any role in the story Doidge tells. Moskowitz, who has switched the goal of his clinic from pain management to pain eradication, recognizes that he himself (and the likes of Pepper) is an outlier set apart by his iron determination. Not all his patients can follow him down his own relentless road. Even so, Moskowitz does not always seek to aid them with drug therapy—instead devoting considerable effort to weaning them from painkillers—but with touch, sound and vibration. It’s a pattern Doidge sees everywhere. “Almost all the success stories involve a combination of mind and energy.”

Much of The Brain’s Way of Healing is devoted to non-invasive energy therapies. The author is particularly enamoured with light therapy, once far more prominent in Western medicine than it is now. Doidge likes to quote Florence Nightingale, who said “Light is not only a painter but a sculptor,” after she took note that wounded soldiers in outdoor field hospitals in Crimea recovered better than those stuck indoors. “We are far more transparent than we think and more sensitive to light than we think. So I have an entire chapter on the use of light, including cold lasers, to heal the brain.”

Light and other energy therapies have fallen from favour, Doidge believes, because for 50 years scientists have focused on the brain’s material and chemical side. Chemicals do work in small regions for signalling, he says, but the true universal language of the brain lies in its pattern of electrical signals. “All our senses take energy from outside and translate it into another form of energy inside the brain. Clinicians can now use these natural forms of energy to ‘talk’ to the brain.” And nothing speaks more loudly and clearly than the electrical pulses of the PoNS.

Originally thought of by its inventors as an aid for brain-injured people with balance troubles, the Portable Neuromodulation Stimulator has astonished even them with its effectiveness over a range of conditions and, especially, the speed with which it helps. (See the book excerpt that follows.) A small, pocket-sized device, part of which went into the mouth and rested on the tongue and part of which stayed outside—144 electrodes that fired off electric pulses to activate the tongue’s sensory neurons. After two weeks of sessions with it, a voiceless MS patient could sing; a woman immobilized by Parkinson’s could walk; a stroke victim who couldn’t understand a newspaper article could read whatever she wanted.

All this because the tongue, Doidge says, “is the royal road to the brain”—with no dead skin and a moist surface making it an excellent conductor, and rich in sensory preceptors for touch, taste and pain that lead directly to the brain stem. “The PoNS turned out to be a very good stimulator for the whole brain.” Doidge thinks it clears up “noise” in the brain caused by disease or injury. “People tend to think neurons are either dead or alive afterwards, but actually many are firing at an irregular or wrong rate. Incoming information is thus chaotic and noise-filled, with even the healthy cells unable to communicate.” The PoNs, via the tongue’s access to the brain stem and hence the entire brain, can reset the circuitry, allow effective electrical communication and return the brain to a state of equilibrium. That’s why the application is so wide-ranging: with the noise gone, the brain starts working with what it has, in whatever condition it finds itself.

For decades, Doidge remarks, scientists wouldn’t use “healing” and “brain” in the same sentence, because they thought the brain was so sophisticated that it lacked self-healing powers. That turned out to be wrong—the brain is even more sophisticated than anyone realized.

EXCLUSIVE EXCERPT:

First he noticed it was becoming hard to sing, a nightmare because that was how he made his living and singing was who he was. Then he could barely sing at all but could still speak his lines. And then over a couple of years he began to lose his speaking voice, until it became wispy thin and trailed off, so that he could generate only short, barely audible bursts of whispered air.

“It was agonizing to watch him lose his beautiful singing voice, heartbreaking. I fell in love with that voice,” said Patsy Husmann, his wife of 50 years. Ron Husmann was a singer of first rank on Broadway, on television, and in film, and throughout the 1960s and 1970s his deep baritone was everywhere. He sang in Camelot opposite Robert Goulet. He co-starred in The Gershwin Years with Frank Sinatra, Ethel Merman and Maurice Chevalier. He starred on Broadway in Tenderloin, and worked with the leading ladies Debbie Reynolds, Julie London, Bernadette Peters and Juliet Prowse in more than half a dozen other Broadway shows. He toured as the lead in Irma La Douce, Show Boat, South Pacific, and Oklahoma! Singing live, in a theatre that held 3,000 people, Ron could be heard by everyone without using a microphone, while the rest of the cast required one.

The bass register begins to mature in richness only in a singer’s thirties, and completely fills out in his forties. Ron was at his peak at 44 when, as he whispered, “it stopped dead.”

As with many people who are eventually diagnosed with multiple sclerosis (MS), it took doctors a number of years—nine, in his case—to realize that his lost voice and a complicated package of other symptoms were caused by MS. In MS, one’s immune system, instead of attacking invading organisms as it should, turns against the brain and spinal cord and attacks the fatty sheath around the long projections of the nerves. This sheath, called myelin, functions as insulation and can increase the speed of the conduction of a nerve signal 15 to 300 times.

Because antibodies can attack myelin almost anywhere in the brain or spinal cord, each patient gets a different version of MS, and each person’s symptoms unfold in a different way. Ron’s deep voice was stripped of its beauty in a series of onslaughts. First the middle tones began to disappear; then suddenly he didn’t have the low notes, for which he was most famous. He went to all the “voice people” who serve performing artists. Onstage, directors had to mike him up so he could be heard, until there was nothing much left to amplify. By the time his singing career was ruined, he was able to hit only about eight notes around middle C.

As the muscles of his legs and arms wasted away, he needed to walk with a cane; then he needed two canes, the kind that go all the way up the arm; then he sometimes had to use an electric cart and gained 50 lb. from lack of exercise. Next he began to have trouble with balance. Standing with his eyes closed, he couldn’t keep himself erect. He had trouble swallowing—always a terrifying symptom. He was increasingly choking on his food because the brain stem, which coordinates the rhythmic contractions of the throat muscles, was no longer working properly. His worst symptom was his unrelenting exhaustion. He got to the point where he could only whisper into the phone for perhaps a minute, until his voice broke up so badly that he imagined he would have to stop trying to whisper altogether.

By coincidence, perhaps, a friend of Ron’s from high school also developed MS and voice problems. Now a retired professor living in Madison, the friend told Ron that a laboratory there, at the University of Wisconsin, had invented a strange device that you put in your mouth to help MS symptoms. The inventors were using the device to treat a range of MS symptoms, not only voice problems. Though it didn’t cure MS, if it was used regularly, it “reset” the brain, so it fired clearer signals and vastly improved its functioning. The lab had a strange name, the Tactile Communication and Neurorehabilitation Laboratory, and it was run by three men: Yuri Danilov, a Russian neuroscientist (and former Soviet soldier); Mitch Tyler, an American biomedical engineer (formerly of the U.S. Navy); and Kurt Kaczmarek, an electrical engineer.

The founder of the lab, Dr. Paul Bach‑y‑Rita, had recruited them. Bach‑y‑Rita, who had recently died, was a legendary figure, one of the first advocates of using brain plasticity in healing. A physician who worked as a neuroscientist, he was the first of his generation to argue that the brain is plastic from cradle to grave, and he used that understanding to develop devices that facilitated positive plastic change. Devices that he developed helped blind people see and helped restore balance lost after brain damage; they also included computer games for stroke patients to train their brains to restore lost functions.

When Ron arrived at the lab, he saw a small, modestly equipped room in an old building. It had a loading dock at its entrance, the hallway was under construction, and as one patient said, it “did not look like the home for scientific miracles.” Ron’s attitude was “This may work, this may not. What have I got to lose?” The team reviewed his medical records and did tests and recordings to determine his ability to walk and balance. They took him to the university’s voice assessment department and recorded his speech, which was incomprehensible, broken up, and appeared as little dots on the monitor. When the baseline testing was complete, they took out the device he had heard about.

It was small, fitting into a shirt pocket. It had a cloth strap attached, and some of the scientists in the lab wore it hanging around their necks, like a pendant. The part that went into the mouth and rested on the tongue looked like a wide stick of chewing gum. This flat part had 144 electrodes on its underside, which fired off electric pulses, in triplets, at frequencies designed to turn on as many of the tongue’s sensory neurons as possible, by generating a pattern of stimulation that roved across the underside of the device. This flat part was attached to a tiny electronics box, about the size of a matchbox, which sat outside the mouth and had some switches and lights on it. Yuri, Mitch, and Kurt called it the PoNS, named, tongue‑in‑cheek, for a part of the brain stem called the pons, one of the device’s main targets. The acronym PoNS stands for Portable Neuromodulation Stimulator, because when it stimulates the neuroplastic brain, it modifies and corrects how the neurons are firing.

The team asked Ron to put the device in his mouth, while he stood as straight as he could. It painlessly stimulated his tongue and its sensory receptors with waves of gentle signals. Sometimes the stimulation tingled, and sometimes it became barely noticeable, and when it did, the team would adjust the dial, turning it up. After a while, they asked him to close his eyes.

After two 20-minute sessions, Ron was able to hum a tune. After four, he was able to sing again. At the end of the week, he was belting out Old Man River.

What was most remarkable was that Ron’s improvement, after almost 30 years of steadily worsening symptoms, was so rapid. He still had MS, but now his brain circuits were functioning so much better. He stayed at the lab for two weeks, working Mondays through Fridays, practising with the device in his mouth, resting, and practising again. He did six sessions a day during the first week—four in the lab, two at home. Electronic voice testing showed huge improvement, a steady stream of sound. His other MS symptoms started to improve. The day he left, the man who had come in wobbling on a cane tap-danced for the team.

I spoke with Ron two months after he returned home to Los Angeles. He had brought the device home to practise with and reinforce his gains. Now that he had his voice back, he was gushing words—at times I had to ask him to talk more slowly, so I could get it all down.

“You can imagine if you haven’t sung for 28 years, what it’s like suddenly to sing again. The fact that I could carry a tune, and hook one note to another, after four 20-minute sessions, was astounding and emotional—more than emotional—I broke down. They told me to hum and vocalize while the thing was in my mouth. I gradually realized my voice was getting stronger. The next day Yuri said, ‘You don’t need that cane.’ That day I got rid of it. By the third day, I was able to stand without any support, and with my eyes closed. By the time I left, I could sing two octaves. I was a bass baritone, and I had a low E that I could sing in public, and when I did Annie Get Your Gun, I got up to an F sharp. And . . . I can be loud now! I was so loud in their lab, they had to put their fingers in their ears. And now when we walk our dog every night, I walk so fast my wife can hardly keep up with me.”

Then he said to me, “Do you realize that we have been talking for a full hour?”

“I wasn’t expecting you to sound younger than I do,” I said finally. “Your voice sounds like that of a man decades younger.”

He took a moment to think. “Well, maybe it should,” he laughed. “I haven’t used it for 30 years.”

]]>http://www.macleans.ca/society/health/how-your-brain-heals-itself/feed/3Living in the cloud of Alzheimer’shttp://www.macleans.ca/society/health/living-in-the-cloud-of-alzheimers/
http://www.macleans.ca/society/health/living-in-the-cloud-of-alzheimers/#commentsSun, 18 Jan 2015 14:56:21 +0000Brian Bethunehttp://www.macleans.ca/?p=664919With Alzheimer’s in his family, Jay Ingram’s search for answers is both professional and personal

Do the math. Well within the next 20 years, all over the developed world and elsewhere too, elderly populations are set to explode as percentages of their national totals, partly because of increasing lifespans and partly because the next generation is so small. People over 65 now comprise 15 per cent of Canadians; by 2030, they will become a quarter of the population. Strides made in their physical care—especially in cardiology—have not been matched by advances in conditions that affect their minds. As the previous scourges of human mortality fade away, more and more of us will live to experience cognitive impairment. Like cancer, dementia is increasingly what’s left to impoverish and end our lives. One in two North Americans over 85 now suffers from dementia, and nothing coming down the medical pipeline promises relief.

The financial burden is already enormous. The value of unpaid dementia care provided by families is at least $50 billion annually in the U.S., as measured by income forgone by members taking time off work and well over $100 billion when measured by what a family would have paid professional caregivers. The situation is proportionate in Canada. In both countries, the cost is more than financial. For almost a decade, Statistics Canada has reported that more than half of those caring for elderly relatives confess to feelings of exhaustion and depression. That’s why Alzheimer’s disease, which accounts for up to three-quarters of dementia cases, has been called “the plague of the 21st century,” writes Jay Ingram in The End of Memory: A Natural History of Aging and Alzheimer’s, and why, he adds, “its shadow lies over us all.”

Ingram, who through 14 popular books and lengthy stints as host of CBC Radio One’s Quirks and Quarks and Discovery Channel’s Daily Planet became Canada’s best-known science commentator, set out to write what he calls a “distanced, scientific” overview of a disease that now stands at the nexus of a scientific puzzle and public health crisis. But there is no escaping the personal with a sickness that is as emotionally draining as any for those watching from the outside or looking to their own futures.

“I’ve been exposed to a fair amount of dementia,” Ingram says in an interview. Although there is as yet no certain pre-mortem diagnosis of Alzheimer’s—only an autopsy can tell for sure—it’s a very safe bet his mother died of it at age 94 in 2006. “For the last four years she was severely compromised cognitively, and for the final two, there was nothing there I recognized as my mother.” Nor was she alone in Ingram’s life. “There was also her sister—my favourite aunt—and my father-in-law. But there’s nothing special in that. In any group of people it doesn’t take long to discover half of them will have had some contact with dementia.”

That’s probably understating the familiarity if the group is primarily female. Alzheimer’s takes a particularly vicious toll on women, both in their role as the world’s primary caregivers and in the fact that perhaps two-thirds of patients are women. Most scientists think that is explained by the same mechanism that is increasing the overall prevalence—longer lives. More women than men reach prime Alzheimer’s years. But Ingram is not so certain. Picking a number almost at random, he says perhaps “two-thirds of the two-thirds is best explained by longevity,” but in the current state of medical knowledge, it’s just as likely there is a yet identified factor also at work, “maybe estrogen-related, maybe not.”

Looming over everyone, male or female, Ingram’s age—he was born in March 1945—is the individual shadow. “Maybe I didn’t realize it consciously at first, but writing this book, thinking about Alzheimer’s,” Ingram says, “I couldn’t help thinking too, ‘I’m nearly 70. In 10 years, if I make it to then, I’m entering into really dangerous territory.’ ” It also made the writer ponder what he calls “the mystery of life.” Looking for a photo of himself as a child to illustrate this article, “was more challenging than I thought it would be. I had thought of the past as, you know, just my childhood. My parents seemed—as they do to many children—old-fashioned and strict in their parenting, but the old photos showed something deeper. There’s a family connection I see now in my own children, in their twenties—a resemblance, a look, a gesture—that makes them part of the larger whole.”

With the natural history of Alzheimer’s, its roots and pathways, as mysterious as it still is, the cloud that lies over our futures can lift or descend like a fast-moving storm. Take Ingram’s situation. One week a study will find, depressingly, that the children of Alzheimer’s mothers are at greater risk of developing the disease than the children of fathers who had it. The next week, other scientists say—bracingly for Ingram, whose father died a month shy of his 98th birthday—that the offspring of long-lived parents are at less risk than the kids of those who had shorter lives.

But on the whole the cloud is black. “I like to tell jokes in my science talks,” Ingram says. “But there really aren’t any good Alzheimer’s jokes.” The official summary of 2014 drug trials, he points out, is another parade of failure. Alois Alzheimer first identified the disease over a century ago, when he examined the dissected brain of Patient Zero, Auguste Deter, a woman he had known in life. Deter was admitted to a Frankfurt mental asylum in 1901. Only 51 years old, her behaviour was paranoid and erratic, her memories tumbling away, leaving just enough self-awareness for moments of heartbreaking clarity: “I have, so to say, lost myself,” she told Alzheimer. Deter died at 55, mute and immobile.

When Alzheimer looked into her brain, he found the disease’s defining features: a vast reduction in the brain cells known as neurons; the plaques, accumulations of the protein amyloid beta; and the tangles, strings of the protein tau. Almost every researcher believes those plaques and tangles are at the root of the disease named after Alzheimer. But in what order of importance—most pick the plaques—and whether as correlates or cause, given that some elderly brains riddled with them belonged to people with no signs of cognitive decline, is still far from certain. Some scientists looking at the way glucose metabolism falls apart in Alzheimer’s patients, have started to think of the disease as type 3 diabetes, a revolutionary concept.

All that is of vital importance, because the efficacies of drug therapies are dependent on the medicine being aimed at the right target. “It’s simply an anxious time for those studying and coping with Alzheimer’s,” Ingram soberly concludes. “By 2025 patients will be putting health care systems up against the wall, but drug development takes a decade or longer. There’s an air of desperation to find something, but I’d be surprised if we had any stabilizing drugs by then. The situation is not good.” All recent drugs have been directed toward the plaques or tangles, but none have been effective—perhaps, Ingram suggests, because they have been given to people only after they have exhibited symptoms. If there is one certain fact about Alzheimer’s, it is that once started its spread is inexorable.

“We’ll have to see what comes out of the Colombia study,” Ingram says in reference to a clinical trial that started a year ago among a related group of Colombians of Basque descent, some of whom have an early onset Alzheimer’s gene—the same gene, although not the same mutation, that killed Auguste Deter—which brings memory loss at 45, dementia at 50 and death soon after. One hundred members will be given a test drug from age 30—and Ingram wonders if that’s too late. The plaques are slow to come to human brains, but the tangles have been seen in 11-year-olds.

That doesn’t mean there’s nothing for sixty- and seventysomethings to do but wait, even if the sturdier protective barriers—a good education, a mentally challenging career—are either in place already or not achievable. “Same old advice as for your health in general,” says Ingram: “diet, especially in regard to sugar, and exercise.” And for a physical disease, there is a strong social component. Solo TV watching correlates dangerously with developing Alzheimer’s; social watching—say, gathering for the big game—points in the opposite direction. Bingo, in fact, may trump chess. And gossip—a source of social bonding and intense cerebral activity, with roots stretching back to primate days—may be the best. All part of the mystery of human life.

]]>http://www.macleans.ca/society/health/living-in-the-cloud-of-alzheimers/feed/0Addicted to foodhttp://www.macleans.ca/society/addicted-to-food/
http://www.macleans.ca/society/addicted-to-food/#commentsSun, 11 Jan 2015 05:32:14 +0000macleans.cahttp://www.macleans.ca/?p=660993‘Like many university students, I had an obsession with weight and food. Today, as a physician, I can see my favourite foods were like drugs.’

Late one night in 1979, I was exhausted and agitated, awake for 16 hours. Should I write my term paper, go out for a run or recalculate my daily allotment of calories to see if I can afford just one more slab of chocolate? I felt as if there was a creature inside me, breathing heavily, getting bigger and more menacing. It wants to eat ferociously but if I give it food, even the smallest bit, it will want to eat everything in sight. It doesn’t care if I’m full or if I plead with it to stop. How will I ever make it through the night? At 23, I was experiencing something I shared in common with 25 per cent of the female population at Canadian universities—an obsession with weight and food. If I had seen a doctor at that time, I would have been diagnosed with an eating disorder, probably bulimia.

Eventually I discovered a way to quell the beast. It came only after trying many strategies, creating rules such as eating junk food only on Saturdays or eating only low-fat, low-calorie items or eating only in the company of others. I tried drugging my cravings with alcohol, working nonstop until the cravings passed. Mostly, though, I just gave in. The only effective solution was also the last thing I wanted to do. Stop eating my favourite foods: donuts, croissants, ice cream . . .

Again and again I tried but I failed. After each failure I’d again try the “common sense” approach of eating properly but my eating habits always slipped back into obsessive unmanageability. If I tried to eat just one smallish dessert each night, it might last one night, or three weeks of white-knuckling, but eventually I gave in to the same old pattern of voracious eating: a slightly bigger dessert followed by two desserts a day followed by desserts replacing nutritious meals.

Today, 35 years later and a practising addiction counsellor and physician, I can look back and see that my favourite foods were like drugs. If I didn’t eat the first cookie, I didn’t want a second, then a third, then more. Like an alcoholic who must give up alcohol for life, I had to give up my trigger foods.

I describe myself as an addict. A respectable addict, of course. Not like the desperate souls who cash in their mortgages or the last of their retirement savings to get their fix. After all, my drug of choice is the cheapest one of all and therefore the most pernicious. And my drug is easily available everywhere: in the gas station’s convenience store and in supermarkets; in a modest diner and in an exclusive restaurant. My friends, family members and colleagues are all users. In fact, many people I know abuse food in some way although if I suggested it, they would say, “What, me an addict? No way!”

In those voices I hear my own years of rationalizations: we all need to eat food; I just require better discipline; I have had a bad day and deserve a treat. My “common sense” thinking that food cannot be an addiction repeatedly led me to yet another relapse, with its secret binging and hoarding.

Even at the best of times, when things were going well in my life, I was continually distracted by the thought of food. At lunch, while a friend excitedly told me about her promotion at work, I silently counted the calories of the cheesecake I had just eaten. I continually forgot, or put off, the resolution made the day before to never to eat this way again. Whenever I would tell myself this is normal behaviour, it was the addict in me talking. In my heart, I knew I was laying the groundwork for the next binge.

All this finally ended a decade ago, when I gave up sugar. Today, whenever I tell myself that I can share one small dessert with a dinner companion, I think, “Who am I kidding?”

Enjoying food is not the same as being addicted to food. Our brains are wired to enjoy food; it’s a primal survival mechanism. We all enjoy foods that are high in both fat and sugar because they’re energy-dense, at one time ensuring our survival when famines were commonplace.

Disordered eating occurs when the natural ebbs and flows associated with the pleasure of eating are scrambled. When you’re very hungry, even a plate of broccoli is extremely enjoyable. Your taste for food diminishes when it is no longer necessary to “fuel up.” If you continue to want food when you’re not hungry, something is wrong.

David Kessler’s book, The End of Overeating, and Pulitzer prize-winning investigative reporter Michael Moss’s Salt, Sugar, Fat: How the Food Giants Hooked Us, argue that it’s the food industry that has deliberately hijacked this universal biological imperative, engineering our food to target the primal part of our psyche that few of us can resist. As Moss writes: “Some of the largest companies are now using brain scans to study how we react neurologically to certain foods, especially to sugar. They’ve discovered that the brain lights up for sugar the same way it does for cocaine.”

To understand how cocaine addiction and food intersect, we must first understand how hunger works. As our stomach empties, a hunger hormone, ghrelin, is released and tells our brain we are hungry. Have you ever noticed that once you’ve decided to eat you realize you have a voracious appetite? This is the work of insulin, another key hunger hormone. Often you have to restrain yourself from picking at the food before you even get to the table.

When we start to eat, insulin levels spike, creating a drive to ensure that we eat the sugar the insulin is designed to transport. As we eat, the curve of pleasure begins to dip; when we are full, we no longer desire food. This curbing of our appetite is also the work of our hunger hormones, linked to our endocrine and digestion system. Once our stomach is full of food, our fat cells release leptin, a hormone that regulates metabolism and body weight, and which tells us we no longer need to eat. Leptin dampens the potency of the insulin-fuelled dopamine spike that gives us the pleasure of eating. Even though the food may still be pleasurable in theory, without the reward urging us on, we should lose interest in it.

But modern society conspires against this perfect feedback loop. When there are many food choices—those “all you can eat” restaurant specials, for example, the tables groaning with plates of steaming noodles, roasted meats, candied vegetables and many varieties of sweets—our dopamine rockets, overpowering the leptin intended to halt our eating.

But I believe there is something more fundamental than external pressures at work here. The drive to overeat suggests a common dynamic underlying our eating behaviour. For the most part, we have not been calling it an addiction. After all, not everyone unable to resist the lure of hyper-palatable foods is a food addict.

What makes eating addictive? The degree to which a person is compelled, even obsessed, to eat. Some are merely tempted, giving in occasionally: willpower works for them. Others, more susceptible to the seduction of food, feel rapture at the sight of a buffet, filling plate after plate of food even after they’ve stopped enjoying it.

As humans, we all sit somewhere on a continuum, with desire at one end and addiction at the other. Some of us eat for healthy reasons—for nutrition, as part of social interaction and, yes, for pleasure. Others eat because they are driven by a need that is beyond willpower or common sense. It becomes a need disconnected from nutrition, interaction or even pleasure. When an eating behaviour leads to a self-destructive end point, when there is a desire to eat that has no “stop” switch, you’ve crossed over into the dynamic of addiction. A growing number of people fit into this category.

In the spring of 2013, my struggle with food was back. Did I really think it had gone away forever? When I looked at the tablespoon of almond butter I felt a surge of warmth and excitement. After the third tablespoon, I knew I was in trouble. The next day, I stared morosely at the jar but still ate three more heaping tablespoons. Why not savour just one more spoonful? I thought.

The next day I barely restrained myself from eating five towering tablespoons. That old, bottomless hunger had resurrected itself. By the end of that month, I was eating more than 10 mammoth tablespoons every night.

Soon the bathroom scale became a terror. After noticing a few extra pounds, I promised myself I would stop once I gained five pounds. Then 10 pounds. To stop eating this trigger food that trapped me in a web of craving and despair didn’t seem possible. It took a year, but I finally took the only action I knew would work: place nut butters in the same category as foods like sugar, bread, chips and pasta, all of which I had given up years earlier. Abstinence was the only solution and once I stopped, the desire gradually faded. I had quelled the craving inside me, but not the disease that had caught me off-guard once again.

I know what you must be thinking. How can a physician and counsellor specializing in food addictions, succumb to this addiction? Based on my personal and clinical experience, I believe that no addiction can be cured, only controlled. As knowledgeable as I am about the issue, I still sometimes naively ask myself: Will my desire to compulsively eat trigger foods always be there? Can I really be addicted to food like a drug addict is to a drug?

But I tell myself, the evidence has shown me, time and again, even to this day, that I will always be a food addict. I need only look to others who have strayed from their diet, even a tiny nibble, and before long, find themselves back to eating uncontrollably. There are many of us out there.

Adapted from Food Junkies: The Truth About Food Addiction. Published by Dundurn Press, the book will be published in January 2015. Dr. Tarman is an addiction medicine specialist focusing on food addictions. She is the medical director at Renascent, a drug and alcohol treatment centre in Toronto.

When Timothy Caulfield attended a star-studded film premiere in Los Angeles last year, he did not expect to be overwhelmed with giddiness at the sight of actors James Franco and Emma Watson. “I’m too cool for this,” he recalls telling himself as he stood among dozens of screaming fans. But, the moment the stars hit the red carpet, Caulfield began to ooh and aah with everyone else. “I got totally into it,” says Caulfield, a University of Alberta professor and Canada Research Chair in health law and policy. It didn’t matter what Franco and Watson were known for, but that they were known, period. “Perhaps we are hard-wired to get excited by individuals with broad cultural status,” he says. Fame, no matter its origin, is electric. It moves us to stand on our toes to see people we know absolutely nothing about, whose talents are sometimes non-existent (Kim Kardashian) or unknown (Kate Middleton). But perhaps, more insidiously, it moves us to buy things we don’t need, and adopt lifestyles that are detrimental to both our bank accounts and our physical health. This is what makes Caulfield uncomfortable. His forthcoming book, Is Gwyneth Paltrow Wrong About Everything? (short answer: yes) is an exhaustively researched, hilarious take on how celebrity culture influences everyday life, from ill-fated attempts to make it big on reality TV to celebrity-endorsed diets and beauty regimens.

Caulfield doesn’t just write about celebrity trends for the book; he tries them out for himself. He stands in line for that movie premiere, attempts (unsuccessfully) to audition for American Idol, and goes on a “cleanse” personally endorsed by Paltrow on her website, Goop, that is tantamount to starvation. The verdict? He loses nine pounds in three weeks and regains the weight almost immediately after he resumes eating like a normal human being.

He does all this to prove that common folk will do almost anything at the suggestion of celebrities, whose spurious claims have built multi-million-dollar businesses. Nowhere is this more obvious than in the health sector, where juice cleanses and gluten-free diets have transformed popular opinion about nutrition in North America, despite a dearth of research on their effectiveness and safety. The cognitive dissonance required to believe that celebrity trends work (the Victoria Beckham bird-poop facial comes to mind) may be evidence that, although we live in a scientifically advanced society, we are grossly lacking in scientific knowledge. Consider the popular term “toxin,” used by health and beauty gurus everywhere (Paltrow included) to peddle their mostly useless wares. According to one popular U.K. blog, Honestly Healthy Food, the No. 1 “stress toxin” in our lives is coffee. No. 2 is “reading or listening to the news.” Caulfield says toxins “are the new evil spirit,” pointing to American writer Eula Bliss’s 2014 book On Immunity, which touches on celebrities’ influence on vaccination rates. According to Bliss, toxins are to the 21st century what filth was to the Victorian age. “Where the word ‘filth’ once suggested, with its moralist air, the evils of the flesh,” writes Bliss, “the word ‘toxic’ now condemns the chemical evils of our industrial world.” No one is better at this type of fear-mongering than celebrity doctors. The problem with people like Dr. Oz is that erroneous information is mixed in with the truth, according to Julia Belluz, a science reporter at Vox Media in Washington. Dr. Oz may promote dietary supplements most people don’t need, but he is also a firm believer in a good night’s sleep. “If half of what he’s saying is sound advice, but a quarter is insanity, how do you tell the difference?”

It may be easier, where Paltrow is concerned, because she is not a doctor. But the unique danger of Paltrow’s brand of faux science is that those who live by it have a desire, presumably, to be like Paltrow herself—to obtain that fresh glow of the eternally youthful, care-free celebrity; an existence that is likely more myth than reality. “Even if an individual makes it big,” writes Caulfield, “the attainment of the goal is unlikely to provide the promised long-term wealth, or, more important, the desired happiness and well-being. There is no pot at the end of the rainbow.”

Getting fit is a perennial New Year’s resolution. Yet many people don’t stick to their vows, balking at the required effort, or pleading that they “can’t find the time” for regular workouts. But could there be a quicker and easier way to get in shape? Martin Gibala, professor and chair of the department of kinesiology at McMaster University, thinks he has the answer: very short, intense bursts of exercise, perhaps for just a few minutes a week.

Q: Canadian health guidelines say people should be doing at least 2½ hours a week of moderate to vigorous aerobic activity. Yet, 85 per cent of us don’t. What’s our problem?

A: I think some people do lead busy lives; they’re very time-pressed. But, quite frankly, for a lot of people, that’s an excuse. You just have to look at the stats on how many hours a day we spend sitting in front of screens or updating social media. We’re not saying the public health guidelines aren’t valid, but people aren’t listening. If, through our research, we can provide some exercise alternatives that are grounded in good science, we think that’s a worthwhile endeavour.

A: On an apples-to-apples basis, if you compare traditional endurance training to HIIT, matching the workloads, there’s compelling evidence that high-intensity intervals produce superior benefits—on cardiorespiratory fitness, for example. But our lab has been interested in the apples-to-oranges—comparing a large amount of traditional training to a relatively small dose of intervals, in terms of both the amount of exercise and the time commitment. What we’re finding is that you can get similar benefits. In other words, you get more bang for your buck.

Q: Your latest study looked at the benefits of a single minute of intense cycling within a 10-minute workout, three times a week. What kind of improvements did you see?

A: In our subjects, we saw cardiorespiratory fitness, or VO2 max, increase by 12 per cent in six weeks. That’s the kind of significant improvement that translates to a 12 to 15 per cent reduction in your risk of developing cardiovascular and other diseases. Blood pressure was also significantly reduced, and their muscles were better at using oxygen and burning fuel. It was a large improvement in ﬁtness, despite the small amount of exercise.

Q: But in that case, all your participants started off in really poor shape. Does HIIT work as well for people who are already fit?

A: Yes. If you look at elite athletes, there are very few who don’t practise some form of high-intensity interval training. It’s been around for decades. But what we’re starting to understand now is that the basic approach of peaks and valleys—going hard and backing off—can be applied safely to many different populations, including those with chronic diseases, and elicit a wide range of benefits.

Q: Is there some magic to cycling?

A: No. We use cycling because we can easily measure work and power and make our comparisons, and it’s low-impact for less fit individuals. But any sort of exercise that engages large muscle groups—swimming, rowing, running—all of those are likely to be effective.

Q: Over the years, you’ve tracked the benefits of ever shorter workouts. Are these three 20-second bursts to make up one intense minute about as low as you can go?

A: I think we’re starting to scrape the bottom, to be sure. Clearly, there’s a minimal amount of work you have to do to stimulate some benefits. However, there really is something to this intensity-duration trade-off. If you are willing to work very, very hard, you can get away with a surprisingly small amount of exercise. But does this mean that someone should train for a marathon by just doing short sprints? Or that people should ignore public health guidelines and just exercise a minute a day, three days a week? No, absolutely, no.

Q: Why not?

A: HIIT shows a lot of promise, but we’re nowhere near having the Grade A evidence we need to say it produces all the benefits of traditional endurance training. One of the main limitations of the studies to date is that they have all been relatively short in duration. We don’t have those sort of year-long, robust comparisons to the traditional approach with large numbers of subjects. We need to go in that direction now.

Q: In your results, there have been some indications that HIIT might not be quite as beneficial for women. Why?

A: That’s another direction the research needs to go in: sex-based differences. It’s a bit grey around measures of how well your body can take up blood sugars, and the risk of developing diabetes. We have now seen, in a couple of our studies, that women appear to respond less well than men to the interval training in that regard. They still improve, but not in the same magnitude. We need to clarify that.

Q: What about nutrition? Can that have a bearing on the effectiveness of HIIT?

A: Absolutely. Nutrition can profoundly influence some of the responses we see. Something as simple as whether you eat breakfast or not can have a bearing on the intensity of a workout. But it varies from person to person; some people are fine going for a long run after a meal. And the studies don’t yet allow us to say, “This is the exact way you have to train.”

Q: Some of the research suggests people actually enjoy HIIT more than traditional exercise. Do you think that’s true?

A: I’ve kind of learned to be careful here. I’m a muscle physiologist, not a psychologist. There are definitely studies that show people rate high-intensity interval training as being more enjoyable. But it really depends when you ask them the question. If you ask them during intervals, they’re more negative. If you ask them after exercise, there’s more enjoyment. Maybe that has to do with people’s fears and taking them out of their comfort zones. Like so many things in science, there are probably individualized responses.

Q: But you’ve been looking into this for more than a decade now. Do you think there are common mistakes people are making when they try to plot a path to fitness?

A: The starting point is that people need to ask themselves why they are doing this. Is your goal performance? General fitness? Weight loss? To bring down your blood sugar? The answer might dictate how you structure an exercise program. At the same time, people are inundated with fitness advice. They read the web, or see stories in the media. It can be information overload. That’s why I think it’s worth making the investment for a few hours with a good, certified personal trainer.

Q: Have you changed your own workouts as a result of your research?

A: The short answer is yes. I do this for a living, so I’m well-motivated to exercise; no one needs to tell me to do it. But I’m also very time-pressed. I have two kids. I’m the typical, middle-aged, working man. So I’ve adopted a very interval-based approach to my training. I do a lot of cycling. I play hockey a couple of times a week. But rarely are my workouts more than 30 minutes; I just try to get the most out of them. In this year’s surveys, the No. 1 fitness trend was body-weight training, where people are doing push-ups and traditional calisthenics-type stuff. That’s a lot of the way I train myself now, because you don’t need a lot of fancy equipment; you can do it anywhere and it can still be very, very effective.

Q: You’ve looked at the way exercise has evolved over the last couple of decades. How will we be working out in 20 years?

A: What’s coming down the pipe is individualized exercise prescriptions. There’s a field that’s known as metabolomics, which is essentially allowing people to get their individual chemical signatures from a saliva or blood sample. In some ways, it’s analogous to what we’re seeing in the field of medicine where, for example, oncologists will biopsy a tumour and tailor an individualized treatment program, because they know certain tumours respond in certain ways. We’re a fair way away from that in the exercise literature, but efforts are already being made to take blood samples, look at the metabolites and get this signature. Then you have people exercise in different ways and see who responds the most and least. Thereby, we can get this picture of which biology responds well to a particular type of training or nutrition, even. So I think we’re going to get better at individualizing the approach. Hopefully, that will help, because, clearly, there are people who follow the public health guidelines and don’t see much of a change, and that’s very frustrating. Then people tell them that they’re not doing it right or for long enough or that they’re cheating. But it may just be that they are low responders to that traditional approach, and perhaps they will respond better to a different type of exercise training, or need some pharmacological help. That’s an important area where we are going to get better.

]]>http://www.macleans.ca/society/health/the-interview-the-benefits-of-short-intense-workouts/feed/0More doctors now keeping patient records electronicallyhttp://www.macleans.ca/society/health/more-doctors-now-keeping-patient-records-electronically/
http://www.macleans.ca/society/health/more-doctors-now-keeping-patient-records-electronically/#commentsTue, 02 Dec 2014 09:13:16 +0000The Canadian Presshttp://www.macleans.ca/?p=646489A survey says the majority of Canadian doctors are now using electronic medical records and other forms of information technology to run their practices

TORONTO – Long reliant on paper-based patient files, the majority of Canadian doctors have now moved firmly into the 21st century, using electronic medical records and other forms of information technology to run their practices, a survey has found.

The 2014 National Physician Survey shows 75 per cent of doctors across the country report using electronic records to enter or retrieve clinical patient notes on a laptop or desktop computer, triple the percentage that had gone digital in 2007.

“I think physicians have wanted to be in the 21st century, but the reality is it’s not a case of flipping a switch,” said Dr. Garey Mazowita, president of the College of Family Physicians of Canada, which administers the survey with two other doctors groups.

“A physician who’s had a long-standing paper-based practice, you have to face the challenge of scanning and digitizing what night be 2,000 charts, with pages and pages of information and entering the information into the correct field,” said Mazowita, who practises in Vancouver. “And these are docs who are already working in excess of 50, often 60 hours a week.”

“It’s just inherently not an easy journey to make the transition.”

Physicians in Alberta, British Columbia and Ontario were the most likely to use electronic records, while Quebec doctors were the least likely, the survey found.

About 65 per cent of physicians reported seeing better or much better quality of care since the implementation of electronic records, a rise of nine percentage points from a year ago.

The benefits most often cited were the ability to get lab results more quickly and to access a patient’s chart remotely, as well as being alerted to potential medication warnings or adverse drug interactions.

Digital record-keeping and being connected electronically to hospitals and labs can now tell a family physician whether a patient has been to a walk-in clinic, seen a specialist or been admitted to or discharged from hospital – a system that didn’t exist before.

“And now, particularly with the family doctors who are completely paper-free, really you’ve ideally got all of that information at your fingertips,” Mazowita said.

Dr. Cindy Forbes, a family doctor in Fall River, N.S., has been using electronic medical records for about eight years, and said going digital has improved quality of care for her patients.

“There’s much better access to patient information like test results, lab results,” said Forbes, president-elect of the Canadian Medical Association (CMA). “You get them back much faster, so we can diagnose and treat patients much more quickly.

“I can’t even tell you the difference it’s made for me in regards to retrieval of information, legibility of information – if you’re reading other doctors’ notes. There was a time when I used to have to leaf through an inch or two of paper files to see what tests patients might have had or operations they may have had in the past. And now with a couple of clicks of the mouse, I can see their history back at least to the eight years I’ve had the computer app.

“So that is a huge difference.”

Being digitally connected enables the family doctor, specialists and hospital physicians all to access a patient’s medical records, thereby preventing duplications of tests and saving time and costs to the health-care system, she said. “There was a time when a test might have been repeated because they didn’t have the results in front of them.”

However, doctors in the survey also identified challenges in accessing information through a digital system: 52 per cent reported technical glitches, 46 per cent had issues with compatibility with other systems, and 26 per cent complained about firewall or security problems.

“There’s this constant game of catch-up being played as the technology evolves,” said Mazowita. “So the whole thing is a bit of a moving target, but we’re definitely seeing movement forward.”

More than 10,000 physicians responded to the online survey, which is also administered by the CMA and the Royal College of Physicians and Surgeons of Canada.

TORONTO –Canada will step up border screening to try to prevent an Ebola importation to this country, federal Health Minister Rona Ambrose said Wednesday.

“Our government will be taking the additional step of taking targeted temperature screens,” she told the House of Commons, though she offered no detail about what that would mean or whether it would be only at airports or all border crossings.

The Canadian Press requested an interview with officials of the Public Health Agency of Canada to get clarification on Canada’s plans, but an interview was not immediately granted.

Ambrose’s announcement came the same day authorities in the United States said that country would start to use enhanced airport screening for incoming passengers at the five airports that handle most flights from the affected West African countries.

And it came a couple of hours after a Texas hospital announced the death of a Liberian man who travelled to the United States before developing the symptoms of and eventually being diagnosed with Ebola.

Officials of the department of Homeland Security and the U.S. Centers for Disease Control said the enhanced entry screening would occur at the following airports: New York’s JFK International Airport, Washington-Dulles, Newark, N.J., Chicago-O’Hare and Hartsfield in Atlanta, Ga. Those airports are the destinations for 94 per cent of all U.S.-bound flights from the Ebola-affected countries.

“We believe these new measures will further protect the health of Americans, understanding that nothing we can do will get us to absolute zero risk until we end the Ebola epidemic in West Africa,” CDC director Dr. Tom Frieden said.

Recently the new head of the Public Health Agency of Canada described the work that is already done by border and quarantine agents who work at Canadian airports. Dr. Gregory Taylor said the agency has spent a lot of time working with the agents and the airlines to help them identify and flag people coming into the country who might be unwell.

For instance, if a passenger on an inbound international flight becomes ill, the pilot will radio ahead to notify authorities. When the plane lands, a quarantine agent will board to assess the passenger and decide whether he or she should be transported by ambulance to a hospital, told to report for a medical assessment within a couple of days or be released.

Likewise, border guards manning the immigration booths in airports are on the lookout for people who appear unwell. Taylor said agents are prompted by a reminder on their computer screens to ask people from Ebola-affected countries if they are ill.

“If the person says yes, then they’re referred immediately to the quarantine officers for a full assessment,” he said. “That’s new and that’s very specific in terms of trying to detect anybody coming from the area who could possibly be ill at the time.

“The border service agents are trained to look for somebody who’s ill. They’re also looking for people who would be sweaty, perspiring, etc. And if there’s any indication _ and they have a series of questions they ask if somebody appears ill, they then notify the quarantine officer who will do an assessment of the person. At that time the quarantine officer has the authority either to demand and detain the traveller.”

However, none of this is foolproof, as authorities well know.

Some diseases, Ebola is one of them, can take a long time to make someone sick. The incubation period for the disease can be as long as 21 days after exposure to the virus, during which time the person would appear and feel well. With Ebola, it is believed people are only contagious when they have symptoms.

Thomas Earl Duncan, the Liberian man who died Wednesday, did not have symptoms when he arrived in Dallas on Sept. 20. He started to feel ill four days later. So airport screening that involved asking “Are you ill?” or requiring incoming passengers to agree to have their temperature taken would not have identified him as a risk.

“If the person is asymptomatic like the U.S. case, that’s not going to pick anything up,” Taylor admitted at a news conference last week. “But we’re hoping to pick up anyone who’s travelling when they’re ill.”

Studies have shown that temperature screening at airports, especially of incoming passengers, is not a particularly effective tool. It was found to have been ineffective during the 2003 SARS outbreak, and during the 2009 H1N1 flu pandemic.

As far as the current Ebola outbreak goes, the risk that Canada might get an imported case is not zero, but it is low, experts suggest.

Dr. Kamran Khan, who studies the spread of infectious diseases by analyzing international air travel patterns, said Canada gets few travellers from Guinea, Liberia and Sierra Leone, the three most badly affected countries in this outbreak. Only 1.5 per cent of travellers from those countries come to Canada, he said.

The months-long outbreak is the worst in known history. On Wednesday the World Health Organization said at least 8,033 people have been infected so far and nearly 3,900 of them have died.

]]>http://www.macleans.ca/news/canada/canada-to-step-up-border-checks-for-ebola/feed/0Hospital staff lacking protections in Liberia are often exposed to Ebolahttp://www.macleans.ca/news/world/hospital-staff-lacking-protections-in-liberia-are-often-exposed-to-ebola/
http://www.macleans.ca/news/world/hospital-staff-lacking-protections-in-liberia-are-often-exposed-to-ebola/#commentsWed, 03 Sep 2014 23:52:50 +0000The Associated Presshttp://www.macleans.ca/?p=602461CHARLOTTE, N.C. – The hospital in Liberia where three American aid workers got sick with Ebola has been overwhelmed by a surge in patients and doesn’t have enough hazard suits…

CHARLOTTE, N.C. – The hospital in Liberia where three American aid workers got sick with Ebola has been overwhelmed by a surge in patients and doesn’t have enough hazard suits and other supplies to keep doctors and nurses safe, a missionary couple told The Associated Press on Wednesday.

The latest infection of Dr. Rick Sacra, an obstetrician who wasn’t even working in the hospital’s Ebola unit, shows just how critical protective gear is to containing the deadly epidemic, and how charities alone can’t handle the response, they said.

Nancy Writebol and her husband David called for reinforcements during the AP interview, which followed her first news conference since recovering from Ebola disease. They work for North Carolina-based SIM, the charity that runs the ELWA hospital in Monrovia, Liberia.

About 250 staffers at the hospital use thousands of disposable protective suits each week, but that’s not enough to fully protect the doctors and nurses who must screen people entering the emergency room or treat patients outside the 50-bed Ebola isolation unit, they said.

“We don’t have enough personal protective safety equipment to adequately be able to safely diagnose if a patient has Ebola. So they are putting themselves at risk,” David Writebol said.

Sacra, a Boston-area obstetrician and veteran of many tours in Africa, felt compelled to return to Liberia about a month ago despite these challenges. As soon as he heard that Dr. Kent Brantly and Nancy Writebol were sick, Sacra called and said “I’m ready to go,” SIM President Bruce Johnson said.

Sacra’s job was to deliver babies at the hospital and take care of patients who were not infected with Ebola. He followed all the protocols to protect himself, said Will Elthick, the group’s operations director in Liberia.

But Sacra got infected nonetheless by the virus that has killed more than 1,900 people and sickened 3,500 in five West African nations.

The disease is spreading faster than the response in part for lack of protective gear, said Tom Kenyon of the U.S. Centers for Disease Control and Prevention. At least $600 million is urgently needed to provide these tools and extra hazard pay so that more doctors and nurses are willing to risk their lives, the World Health Organization said Wednesday.

Health care workers at other West African hospitals have gone on strike demanding more protections, the Writebols said.

“They are saying, ‘I can’t go to work safely until there is personal protective equipment available, the right gear, the right procedures in place. And then, if they don’t go to work, are they going to get paid?” David Writebol said.

The Writebols are veteran missionaries in Africa; David helped with the hospital’s technology while Nancy helped dress and disinfect people entering and leaving the Ebola unit. They say the challenges are far bigger than what any one hospital can handle alone.

Liberians were already struggling to survive before Ebola, and now it’s even more chaotic, they said. The numbers of patients are surging, and finding food and supplies is more costly and difficult since airlines stopped serving the country.

Ebola has “overwhelmed the supply chain,” David Writebol said. “They can’t get equipment in because there aren’t any regular flights coming in. Same thing with aid workers from the international community. There are only a limited number of seats available to come into Liberia. … That’s one of the biggest problems getting medicine, protective gear and supplies for health care workers who are there.”

Nancy Writebol said the emergency room is often where patients would show up first, and people showing symptoms were ushered into triage. But health workers were sometimes exposed as they screened these patients, who may not have known or advertised that they were carrying the virus.

And sometimes, the sick would leave before finding out if they had Ebola. “Those are the people you really worry about going back into the community, because if they are sick with Ebola, it will ultimately spread,” she said.

Sacra immediately got tested for Ebola after coming down with a temperature, his brother Doug Sacra told the AP. Like his colleagues he also went into isolation to avoid spreading the virus.

Some other doctors haven’t been so rigorous.

The WHO announced today that a doctor in southern Nigeria was exposed by a man who evaded surveillance efforts, and then in turn exposed dozens of others by continuing to treat patients after he became ill. Then he died, and his family and church members followed their funeral traditions by laying their hands on his body.

Now his widow and sister are sick and about 60 others in the city of Port Harcourt are under surveillance.

Sacra, who left behind his wife and three grown children for this latest trip to Africa, was in good spirits Wednesday and able to send emails, Elthick said, which could mean that he’s physically well enough to be evacuated.

It’s not clear where Sacra would be treated. Experts say any fully-equipped hospital that follows the latest safety protocols could prevent a U.S. outbreak while caring for an Ebola patient, but there are four high-level isolation units in the United States designed especially to handle dreaded infectious diseases.

The largest of the four, with 10 beds, is at the Nebraska Medical Center in Omaha. Hospital officials there have been told to be ready to receive a patient, though they were told the same thing before Brantly and Writebol were evacuated to Emory University Hospital in Atlanta, medical centre spokesman Taylor Wilson said Wednesday.

The other two units are National Institutes of Health facilities in Maryland and Montana.

EDMONTON – Alberta’s privacy commissioner says a chain of medical clinics failed to protect patients’ health information on a laptop that was stolen — and took too long to publicly report the theft.

The commissioner’s office released its report Friday into the breach, along with several recommendations for Medicentres Inc., including one that the company update its notification policy.

An information technology consultant who had taken his laptop from work lost it at a public venue on Sept. 26, 2013. Nine days later, when the laptop couldn’t be found, the company reported the theft to police and the privacy office.

The company didn’t tell the government or the patients and their doctors until January.

The laptop contained key information from about 621,000 patients, who had been seen by doctors at the company’s Alberta clinics dating back to May 2011. The computer was password-protected but not encrypted.

Encryption is a “no-brainer” that the privacy office has been recommending to health providers for years, said Brian Hamilton, the office’s director of compliance and special investigations.

In addition, he said, Medicentres failed to properly inform the consultant of its security policies and didn’t conduct regular checks on his work.

“This really speaks to governance and delegation of authority and being aware of what your service providers are doing,” Hamilton said.

The report further criticized the four months Medicentres took to inform the patients and their doctors.

Disclosure wasn’t mandatory by law at the time. But the privacy office had guidelines stating anyone involved in a breach should “immediately” respond and notify affected individuals. The report said staff repeatedly told Medicentres that it should notify people, but the company “spent considerable time considering and rejecting various methods of notification.”

Hamilton said Medicentres technically adopted the privacy office’s guideline, but without a time factor, and should revise its approach to “make sure its responses are more timely.”

Health Minister Fred Horne said he was outraged by the delay when he learned about it. He was also angry that the privacy commissioner wasn’t required to inform him about the breach.

Since then, changes have been made to the province’s Health Information Act that require mandatory notification of people affected by privacy breaches. Violations carry a minimum $2,000 fine for an individual and $200,000 for a corporation.

Horne said details, such as how many days should be allowed for notification, are still being discussed but should be finalized in the fall.

“This should never happen again,” he said Friday.

Dr. Arif Bhimji, chief medical officer for Medicentres, said the company needed time to pull together a team to respond to the phone calls it would receive from people about the laptop breach.

Four months was “not unreasonable,” he said.

“I think moving forward we would try to do things sooner, but I’m assuming that we will never have this situation again.”

Many of the report’s recommendations have already been made and others are being “worked on,” Bhimji said.

Medicentres has also stopped hiring consultants, he added, and will only do so again if they work strictly out of company offices with company equipment.

Medicentres was recently in court asking for a stay on the release of the privacy commissioner’s report and a publication ban on its contents. The judge dismissed the application.

Bhimji said the company wanted more time to respond to a draft version.

Court of Queen’s Bench Justice Robert Graesser wrote in his decision that the company’s main concern seemed to be “the potential impact the final report may have on the intended class proceedings it faces.”

A multimillion-dollar, class-action lawsuit against Medicentres was filed in June on behalf of patients who had their personal data stored on the laptop.

Medicentres and the privacy office agree that, so far, none of the patients has fallen victim to an identity crime.

]]>http://www.macleans.ca/society/technology/privacy-office-finds-alberta-clinic-failed-to-protect-patient-data/feed/0Is it ethical to use experimental treatments to treat Ebola?http://www.macleans.ca/society/health/who-wants-to-debate-the-ethics-of-experimental-ebola-therapies/
http://www.macleans.ca/society/health/who-wants-to-debate-the-ethics-of-experimental-ebola-therapies/#commentsSun, 10 Aug 2014 10:40:03 +0000The Canadian Presshttp://www.macleans.ca/?p=592151WHO wants to debate the ethics of using Ebola therapies that have not yet been tested on humans

TORONTO — On Monday experts from around the world will converge, by telephone, to try to chart a path through a mine field of ethical issues related to the expanding Ebola outbreak in West Africa.

The experts — ethicists and representatives of the affected countries and other players involved in the outbreak — are meeting at the request of the World Health Organization to debate whether it is ethical to use experimental Ebola therapies in this epidemic.

Most of the treatment options, including the one given recently to two American aid workers, have never been tested in humans. Studies in Ebola-infected primates provide the strongest clues of whether these potential drugs and candidate vaccines might work on people and whether they are safe for people to use.

The ethical questions are thorny, especially given the number of available doses or treatment courses is vanishingly small — nowhere near enough to make a dent in an outbreak that has already claimed close to 1,000 lives. Nearly 40 per cent of all known Ebola deaths ever have occurred in this outbreak, which is far from over.

“You have experimental products which have never even been used in humans, in healthy volunteers. And in addition, there is very, very little of it. So what do you do with it?” Dr. Marie-Paule Kieny, the WHO’s assistant director general for health systems and innovation, says in describing the dilemmas the ethics panel will be asked to help the WHO work through.

“Of course it should be used but for whom and how?I think you could make a case that if they are to be used, they should be used also in a condition where it is possible to learn as much as possible from their use.”

Researchers have been trying to develop Ebola drugs and vaccines for years. But even the most promising projects eventually run up against what has been an intractable problem: The only way to know if a vaccine prevents Ebola infection or a drug cures it is to use it in an outbreak. The idea of using in Africa drugs for which there is little or no human safety data makes many people shudder.

“You need to reassure the governments and the regulators in these countries that you are not just taking their citizens and using them to do research,” Kieny insists.

Dr. Ross Upshur, former director of the University of Toronto’s Joint Centre for Bioethics, says the idea of using experimental drugs needs sober reflection.

“Trust me, I am no friend of Ebola,” says Upshur, now a professor at the University of Toronto’s Dalla Lana School of Public Health. “But taking whatever might be out in however many labs around the world and starting to stick them into people without a good clear (study) protocol, without informed consent, without regulatory oversight would be foolish.”

“We need to be really clearheaded about this, because it will also be precedent setting.”

Many of the questions the panel will debate will inform decisions that will need to be taken down the road. Right now there is almost nothing to distribute, people familiar with the various research projects say. Making experimental drugs or vaccines is expensive business, and the laboratories and biotech companies doing this type of early research only produce tiny batches.

Take for example the therapy used by Americans Dr. Kent Brantly and Nancy Writebol, a cocktail of three monoclonal antibodies that attack proteins on the surface of the Ebola virus.

Mapp Biopharmaceutical, the company behind the product, has “fewer than a handful” of treatment courses left of the drug, called ZMapp, says Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. Another source is more specific, saying that after Brantly and Writebol were treated, there was only enough drug left for three people.

“So this idea about (opening) the cupboard: There’s no cupboard right now. That’s like a moot point about distributing it because there’s very, very little,” Fauci insists.

It is estimated that making another batch of ZMapp could take three to four months. “This is something so new and experimental it (production) has not been scaled up,” says Kieny.

Another potential option for compassionate use is a therapy called TKM-Ebola, made by Tekmira Pharmaceuticals of Burnaby, B.C.

The drug binds to the RNA of the Ebola virus, blocking its ability to make disease causing proteins. It has been given to some healthy human volunteers. But the study was suspended by the U.S. Food and Drug Administration because of concerns over what has been described as a safety signal when the drug was given at high doses.

Last week the FDA partially lifted that hold, potentially allowing the drug to be used in the outbreak. Tekmira President Dr. Mark Murray said the company would be willing to assist in any responsible use of the drug. But the company will not disclose how many doses of TKM-Ebola it has on hand, or how long it will take to make more.

Prior to the emergency use of ZMapp, most experts argued that experimental drugs could not be used safely in this outbreak. There is too much panic and hostility among people in affected communities, the argument went. Use of anything new, especially something injectable, would only fan the raging rumours that the response workers are spreading Ebola, not trying to treat it.

But since the Brantly-Writebol incident, opinion has shifted.

Three leading public health leaders — Dr. Jeremy Farrar, head of Britain’s Wellcome Trust, Dr. David Heymann, head of the Chatham House Centre on Global Health Security in London, and Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine — argued last week in the Wall Street Journal that it is time to fast-track safety testing of the therapies in healthy volunteers in unaffected countries, so that drugs can be tested in African in this outbreak. They note the epidemic is likely to continue for months.

And that is probably the most optimistic timeline for having any product to test in Africa. Fauci says his organization plans to begin a Phase I clinical trial of an Ebola vaccine in September. Phase I trials involve giving something to a small number of healthy volunteers to see if it is safe. With a vaccine, a Phase I trial could also show if recipients developed Ebola antibodies.

“If it’s successful and if it’s safe and if it works, then we would hopefully be able to sometime in late 2015 have some to be able to give to health-care workers who are going to put themselves on the line,” says Fauci.

While more than a year away, that is lightening speed for a vaccine that hasn’t yet been given to people. Still, everyone hopes this outbreak will be over by then.

In the meantime, Kieny says, the WHO is exploring the possibility of helping the affected countries develop convalescent serum — blood from survivors which would contain Ebola antibodies — and hyperimmune globulin, a more concentrated antibody serum. Both these therapies are used for a variety of illnesses; hyperimmune globulin, for instance, is used to treat people who have been exposed to rabies.

“Neither convalescent serum nor hyperimmune globulins are there yet,” Kieny says. “But this is something that could be worked on and be available in the coming few months.”

]]>http://www.macleans.ca/society/health/who-wants-to-debate-the-ethics-of-experimental-ebola-therapies/feed/1Ebola virus: What you need to knowhttp://www.macleans.ca/news/need-to-know/ebola-what-you-need-to-know/
http://www.macleans.ca/news/need-to-know/ebola-what-you-need-to-know/#commentsTue, 05 Aug 2014 17:44:03 +0000Genna Buckhttp://www.macleans.ca/?p=589659What the world is doing to control the worst Ebola virus outbreak in history—and why the task is so difficult

A WHO team buries the bodies of deceased patients whose families did not come near the Médecins Sans Frontières (MSF) Ebola Treatment Center in Kailahun, Sierra Leone.

Six months after the first signs of trouble, 1,711 infections and 932 deaths from the deadly Ebola virus have the rest of the world finally catching the panic, if not the disease.

Controlling the disease

Experts expect the outbreak to rage out of control in the West African nations of Guinea, Liberia and Sierra Leone until at least the end of this year. The World Health Organization is warning the disease is moving faster than efforts to stop it. Talks are taking place in Geneva to determine if the organization will declare a global public health emergency.

The international community is waking up to the crisis. The WHO and leaders of the three affected countries have announced a joint US$100-million response plan. Public health officials in Britain held a meeting this week to plan for the possibility of the virus reaching their shores. Borders and schools are finally being shuttered in affected areas in West Africa, where everyone from civil servants to soccer stars are ordered to stay home and avoid public gatherings.

Canada has donated $1.4 million to help fight the outbreak and advises against all non-essential travel to the affected areas. The national public health agency, stressing that the risk to Canadians is miniscule, has asked Canadian border officials and family doctors to keep an eye out for people who may have been exposed.

The July 25 death of Patrick Sawyer, an American working for the Liberian government, proved to be a turning point in the perception of the outbreak. Sawyer managed to get on a plane in Liberia and pass through a major transportation hub in Togo before collapsing at the airport in Lagos, Nigeria. He died of Ebola a few days later. About 70 people he had contact with are being monitored. At least one Nigerian caught Ebola from Sawyer; seven others are showing symptoms.

On Aug. 5, a man who had recently travelled to Sierra Leone died in Saudi Arabia after showing “Ebola-like symptoms.” If confirmed, his will be the first Ebola death outside of Africa in this outbreak.

Two more Americans who contracted Ebola during an aid mission in Liberia are to be treated at a hospital in Atlanta. Kent Brantly, a doctor, and Nancy Writebol, a personnel coordinator, are the first known Ebola victims on North American soil. Brantly, who arrived stateside Aug. 2, told NPR he followed protection protocols to the letter and has no idea how he got the virus.

Both Americans seem to be improving after treatment with an experimental antibody therapy that was developed in part at the lab run by Dr. Gary Kobinger at the University of Manitoba. The drug, which is called ZMappand is made by a company called Mapp Biopharmaceutical, had never been tested on humans before, is not heat-stable and is not mass produced. Both Writebol and Brantly consented to try the treatment and accepted the risks. Conducting drug trials in the field during an epidemic is not an accepted scientific practice, but the WHO has convened an ethical review on experimental therapies. Another drug company, Sarepta, has an Ebola drug under development. It’s been used with some success on monkeys, but funding for the research dried up two years ago. The company has only a few dozen doses of the drug on hand.

Sheik Umar Khan, a leading Ebola doctor in Sierra Leone, and Samuel Brisbane, his counterpart in Liberia, have died of the disease in recent days. A Ugandan physician, Samuel Muhumuza Mutoro, died earlier this month in Liberia.

How it spreads

Ebola is a viral haemorrhagic fever, part of a group that includes some of the most virulent, deadly and certifiably terrifying diseases known to science. It causes a rapidly climbing temperature, weakness, full-body pain, vomiting, diarrhea, and sometimes internal and external bleeding. Simple measures like fever control and IV rehydration and fever control can knock the 90 per cent fatality rate down to around 60 per cent. There’s no proven treatment and no vaccine. But most Ebola patients spend their last days in isolation, often bleeding from their eyes and noses, before dying surrounded by people in haz-mat-style suits and goggles.

The protective gear is designed to prevent direct contact with bodily fluids. Although some transmission by droplet spray is apparently possible, Ebola mercifully does not hang around in the air like influenza or the common cold. As a virus, it’s a sheep in wolf’s clothing. It’s no match for sunlight or household bleach, and handwashing with soap and water can control its spread. That’s why experts are universally reassuring that an outbreak anywhere in the Western world would be contained and stamped out easily. However, victims aren’t contagious until symptoms appear, which can take up to three weeks—plenty of time to travel far from the point of infection.

Fruit bats, which are found across Africa and eaten as a delicacy in many places, are thought to harbour the virus. Since it was identified in 1976 in what is now the Democratic Republic of the Congo, Ebola has been playing a grisly game of Whac-a-Mole with public health authorities; surfacing in east or central Africa every few years and infecting a handful of people. This is the first West African outbreak and the only time there’s been significant spread in urban areas. Doctors Without Borders suspects it originated in February among bat hunters near Guéckédougou, Guinea. Now it’s tearing through a densely populated area, which is already recovering from decades of civil war. Migrants seeking work in the booming mineral sector easily spread the disease across notoriously porous borders.

To make matters worse, the Kissi people, who live in all three countries, traditionally keep the bodies of dead loved ones at home for several days. At funerals, mourners touch and kiss the body in farewell. Richard Preston, documenter of tropical diseases and author of The Hot Zone, sheds some light on why that’s so risky: ”In severe cases, Ebola kills so much tissue that after death the cadaver rapidly deteriorates. In monkeys, and perhaps in people, a sort of melting occurs, and the corpse’s connective tissue, skin, and organs, already peppered with dead areas and heated with fever, begin to liquefy, and the slimes and uncoagulated blood that run from the cadaver are saturated with Ebola-virus particles.”

A parallel epidemic of panic and paranoia has proven almost as deadly as the virus itself. Thousands of protesters stormed a hospital in western Sierra Leone last week after a former nurse spread the pernicious rumour that Ebola is a cover story for cannibalism. An infected woman, also in Sierra Leone, set off a nationwide manhunt when her family wrestled her from a treatment centre and took her to a traditional healer. Police tracked her down after several days, but she died in the ambulance on the way to another hospital. In Liberia’s capital, Monrovia, a survey by the humanitarian group Samaritan’s Purse found 92 per cent of local people believe Ebola is a hoax.

The term “litterbug” was popularized in the 1950s in public service announcements produced by Keep America Beautiful, a non-profit composed of government agencies, citizens, and corporations—Philip Morris, Anheuser-Busch and Coca-Cola, among them. The group wanted to draw attention to the growing problem of litter on newly built highways. The campaign was a success; “litterbug” remains a pejorative. But putting the onus on individuals as the cause ignored a larger, systemic problem we’re grappling with to this day: the excessive, extraneous packaging of consumer goods.

The litterbug story came to mind when I spoke recently with three scientists at the Public Health Agency of Canada (Gregory Taylor, deputy chief public health officer; Robbin Lindsay, head of field studies; and Nick Ogden, senior research scientist) about the agency’s new Lyme “action plan,” which includes talking to journalists to get the word out. An initiative to raise awareness, and to improve diagnosis and treatment, of the tick-borne infection is desperately needed in this country. Incidence of Lyme is on the rise, abetted by global warming, which extends ticks’ habitats. The spectre of a Canadian “Lyme epidemic” prompted Green Party Leader Elizabeth May to propose Bill C-442, itself a “national action plan” on Lyme disease. It passed through third reading in the House of Commons in June and has been referred to the Senate.

The bill was necessary. Canada has assumed the ostrich position toward Lyme for decades. Stories abound of people eventually diagnosed who were initially told by their doctors that they couldn’t have contracted Lyme because black-legged ticks don’t live in the vicinity. Lawsuits have been launched, one against the Canadian military. Lyme misdiagnosis in Manitoba is the subject of a Ph.D. thesis. It is a topic riven by rancorous debate. One area of dispute is the conventional wisdom that Lyme almost always announces itself via a bulls-eye rash. Lyme advocacy groups and “Lyme-literate” doctors dispute this—a position backed by a recent study of children in Nova Scotia that found undiagnosed Lyme led to arthritis: 76 per cent of those children showed no sign of a rash.

Related:

As that story illustrates, getting Lyme diagnosed can be difficult. As reported in Maclean’s, the two-tiered testing protocol used in Canada and the U.S. is riddled with false negatives and is unable to detect all bacterial strains and co-infections. Health Canada said as much in a 2012 advisory. Lyme’s early symptoms—fever, chills, joint pain, headache—accompany many conditions. Yet, early detection and treatment is critical; untreated Lyme affects neurological and motor functions, manifesting symptoms often misdiagnosed as MS, Parkinson’s and ALS. Lyme advocacy groups refer to this as “chronic Lyme,” a definition rejected by the Canadian government and by the Infectious Disease Society of America (IDSA), which sets Lyme treatment guidelines. They both refer to lingering or worsening symptoms as “post-treatment Lyme syndrome,” which assumes Lyme was identified and treated in the first place. Here, too, debate is polarized. IDSA guidelines advise Lyme can be effectively treated with no more than four weeks of antibiotics. Lyme advocacy groups and doctors believe long-term antibiotics are required to vanquish the infection; Canadian doctors who’ve treated “chronic Lyme” with long-term antibiotics have been disciplined and/or seen their medical licences revoked, sending many Canadians to the U.S. for treatment.

It would be good to report that the government’s new “action plan” brings clarity, direction and help to Canadians suffering from Lyme disease—as well as those currently undiagnosed. But, fairly quickly, it becomes clear that by “action,” the government is referring to what people need to do to avoid being bitten by a tick in the first place. A big part of its awareness and education includes directives: Wear long sleeves and light colours in the brush; use bug repellant; shower after being outdoors; do daily “full body” checks for ticks on yourself, children and pets. Those who find a tick are advised to send it in for analysis. Canadians are also told to keep their lawns “well-maintained” and “to seek medical help if experiencing a range of symptoms.”

“We would like to see people not get infected at all,” says Gregory Taylor, optimistically. Anyone with a history of walking in the woods who has seen a tick and has some of the symptoms should seek help and receive early treatment to avoid “having the long, bad outcomes with Lyme,” Taylor says. That scenario suggests Lyme is a rural concern—which it’s not, as the directive to tend lawns makes clear. Similarly, a focus on spring and summer as “tick season” suggests ticks are seasonal, like corn or peaches. But they live through the winter as well.

Yet, let’s say someone walks in the woods, sees a tick, and has symptoms. The system they face remains unchanged—and that’s a big problem. The government plan promises “improved diagnostic methods, as they become available.” But Taylor expresses satisfaction with the status quo: “I think diagnostic testing in Canada, currently, is on a par with what’s in the U.S., and it’s a validated test,” he says. Treatment protocols are outside the government’s purview, says Taylor, though he speaks enthusiastically of research on antibiotics used as a prophylactic on those exposed to a tick bite, before symptoms emerge. He expresses concern about long-term antibiotic treatment, noting risks of antibiotic resistance and diarrhea. More research is needed, he says. Even so, he speaks of a system fixed in its ways. Doctors diagnosing conditions with Lyme-like symptoms reject the Lyme diagnosis, he says: “Specialists in neurology or rheumatology don’t believe it’s Lyme.”

The action plan also focuses on tick surveillance—along with “new methods of controlling the ticks that carry and spread Lyme disease.” Jim Wilson, president of the Canadian Lyme Disease Foundation, expresses skepticism: ”I wish them luck with that,” he says. His organization has been involved in ongoing consultation with the government; one condition of its participation, he says, was that the government update information to say a bulls-eye rash is not always present in most Lyme cases. Talking to government scientists, “messaging” about the rash is still unclear. Taylor reports that 75 to 80 per cent of Lyme cases are accompanied by a bulls-eye rash; Lindsay interjected to say that a rash is seen in fewer than 80 per cent of cases and that it may not always look like the classic bulls-eye. “We’ve altered our messaging away from that,” Lindsay says. Still, doctors looking for information about Lyme on the government’s website will find it says that a bulls-eye rash is present in 70 to 80 per cent of cases.

Clearly, the government is under pressure to show leadership. But the fact that it’s focusing on a Lyme “action plan” suggests it’s out of touch. What’s needed instead is a “tick action strategy,” given rising incidence of diseases spread by ticks, including babesiosis, which has been dubbed “American malaria” because it can be fatal. In 2012, the Centers for Disease Control was notified of 911 cases in the 22 states where incidence is reportable. Less than half of those reporting it—43 per cent—recalled having a tick bite in the eight weeks before symptom onset. It’s also spread via blood transfusion and from mother to child. Seven cases of babesiosis in blood recipients were classified by the reporting state as transfusion associated; one reported case was attributed to congenital transmission from mother to child.

When I asked what measures are being taken to ensure the Canadian blood supply is safe, Taylor said there is “no evidence of anyone being infected with Lyme via blood transfusion.” Lindsay jumped in to say several hundred cases of babesiosis have been reported in the U.S., but the risk in Canada is far lower. Canadian Blood Services has been conducting serological surveys on close to 30,000 blood donors and none was positive, he says. Still, there’s “concern” about babesiosis in future, Lindsay says: “In some locations, we are starting to see what appear to be established infections within small mammal populations.”

CanLyme’s Wilson sees the government’s “action plan” as pre-emptive. “They know what’s coming down the pipes,” he says. According to Health Canada, there were 500 reported cases of Lyme in Canada last year, up from 128 in 2009, when the agency started keeping track. At a hearing into Bill C-442 in May, an infectious disease specialist claimed Lyme “will affect more than 10,000 Canadians per year by the 2020s.” Wilson believes we’re at 10,000 Lyme cases annually. He expresses concern that no infrastructure is being built to deal with the mounting numbers: “We’re talking billions of dollars in health care and other tax dollars of social assistance [for people disabled by Lyme],” he says. Instead, Canadians are being told to conduct full body searches for ticks—not unlike the motorists who were told 60 years ago that not tossing a wrapper on the highway would somehow, magically, solve the problem.

]]>http://www.macleans.ca/society/health/health-canadas-new-lyme-disease-plan-you-act-well-watch/feed/6Preview: Does this girl hold the genetic key to how we age?http://www.macleans.ca/society/health/preview-does-this-girl-hold-the-genetic-key-to-how-we-age/
http://www.macleans.ca/society/health/preview-does-this-girl-hold-the-genetic-key-to-how-we-age/#commentsWed, 16 Jul 2014 18:12:17 +0000macleans.cahttp://www.macleans.ca/?p=582609A sneak peek at this week's cover: A five-year-old Alberta girl is trapped in the body of an infant. Scientists think she may hold the key to the secrets of aging

Every year, on her birthday, Mackenzee Wittke gets the same cake. It’s a homemade Rice Krispies treat, gooey with marshmallows and butter, moulded into the shape of a number: one for her first birthday, two for her second, and so on. Every year, as she hits another milestone, her parents, Kim and Matt Wittke—who live in the Edmonton suburb of Sherwood Park—snap a photo of her next to the cake. These pictures are a timeline of five-year-old Mackenzee’s life so far, and they reveal something startling: From one year to the next, as the number-shaped cakes tick upward, this girl has barely aged.

Today, about to turn six, Mackenzee weighs 16 lb. and measures just under 30 inches. Doctors and specialists say that, physically and cognitively, she’s the age of a six-month-old baby.

No medical expert has ever been able to explain Mackenzee’s condition; all genetic and chromosomal tests come back normal.

Science writer Kate Lunau tells the story of the Wittke family in Maclean’s this week. As Lunau explains, there are scientists who believe that solving the mystery of why Mackenzee seems frozen in time will answer one of life’s biggest questions: how we grow old.

You’ll find the story in our print edition, which hits stands Thursday. Read the digital edition on tablet or iPhone later today. We’ll post it here early next week.

A program meant to improve the health outcomes of Aboriginal mothers and babies in northern Manitoba by training more midwives has produced only eight graduates in eight years. The province and federal government have spent roughly $8 million on the project, translating to $1 million per graduate so far.

Enrolment has now been halted until 2015.

After extensive—and expensive—consultations, the kanaci otinawawasowin bachelor of midwifery program was launched in 2006 at the University College of the North (UCN), whose main campus is in The Pas.

The program’s development was made possible by a $1.6-million grant earmarked for Aboriginals from Health Canada’s Primary Health Care Transition Fund. That funded a small staff and plenty of travel. About 150 people were bused and flown to the far North for a ceremony to honour traditional midwives and a conference to consult on curriculum. Staff and instructors also travelled to Arctic College in Rankin Inlet, Nunavut and Six Nations territory in Ontario to learn about best practices in Aboriginal education.

The program has received provincial funding of $6.3 million since 2006 (roughly $787,500 per year) and accepted 26 students over eight years. For comparison’s sake, the University of British Columbia’s four-year Bachelor of Midwifery program currently has 68 students and an annual operating budget of approximately $1.4 million.

There was a rough start for UCN’s program when an agreement with a federal hospital and a regional health authority to allow access for students to attend births took years longer than expected, leaving students without enough experience to graduate and get certified. Of nine students who started in 2006, only one finished. Four sued the university over the inability to complete the program. The university provided a confidential settlement.

In 2010, the program was mostly shipped south to Winnipeg, where it accepted a new class.

Dr. Linda Ross, director until her three-year term ends on July 31, was not available for an interview, but sent a letter to say she is proud to report that a total of eight students have graduated and are employed, or have offers from regional health authorities after they passed the Canadian midwifery registration exam. A ninth will write her exam in the fall.

As for the small number of graduates, Ross writes that the program has suffered from a lack of midwives to oversee students. “While the current graduates were students, there were approximately 40 midwives in Manitoba,” she writes. “Midwifery students, as is the case with medical students, nursing students, etc., require clinical supervision by practising midwives. Therefore, student numbers are constrained.”

A spokesperson from the ministry of Advanced Education wrote that a new program is being created by UCN and the University of Manitoba. “The two institutions are committed to working collaboratively on developing the bachelor’s program that will serve Northern and Aboriginal families drawing upon U of M’s expertise to enhance the current program. Once the new program is up and running, enrolment is expected to exceed the current 10-seat capacity.”

Melissa Brown, a recent graduate from Winnipeg who is part Ojibway and part Navajo, says she isn’t pleased the program has been halted, nor does she know why it happened. “All I heard is that UCN is a young university and needed more support,” she says. “I have just as many questions as you.”

Although Brown says the program was of high quality and the instructors worked hard to respond to students’ needs, she says there wasn’t enough traditional Aboriginal knowledge provided. She arranged for the class to meet elders and attend sun dances after her classmates (most of them non-Aboriginal) expressed interest in learning more about First Nation cultures.

Darlene Birch, a practising Aboriginal midwife who lives in Norway House, helped to apply for the initial funding and instructed students full-time in the first four years of the program. She says the program’s slow start was partly because of poor communication. She won’t comment on whether taxpayers have received value for their money. She agrees with Brown that the program has lost “basically all the Aboriginal content,” except for the short placements students took on-site with her in Norway House.

During those visits, she taught students to prepare traditional medicines and advocate for patients. Pregnant Aboriginal women often need help navigating the system, she says, whether to book ultrasounds or find emotional support in urban centres, where they are often flown near the end of their pregnancies so they can give birth in hospitals.

Birch is sitting on a committee that will try to fix the program, and she is hopeful it will get back on track, so that more Aboriginal women can receive care in the future. “There’s a tragic lack of access,” she says. “There’s three times the mortality rate for newborns [than] in any other part of Canada. You address that by putting the caregivers where they’re needed, and you want people who are culturally respectful.”

As John Maynard Keynes wrote, “In the long run, we are all dead.” And the No. 1 cause of death in Canada is cancer. Number 2 is heart disease. But after those two causes, each province and territory is slightly different, when it comes to ranking their remaining leading causes of death. We’ve highlighted the one that most disproportionately affects each province, compared to Canada as a whole.

Last week, as Stephen Harper’s Conservatives marked eight years since their rise to power, the Health Council of Canada delivered what seemed to be a rather inconsiderate anniversary gift. The council released a report that placed Canada dead last, among 11 prosperous countries surveyed, when it comes to how quickly patients can get an appointment with a regular family doctor. Faced with that news, Rona Ambrose, the federal health minister, issued a statement pledging to “continue to work with the provinces and territories on reducing health wait times.” But John Abbott, the council’s chief executive officer, described the Harper government’s level of engagement on the problem as “close to zero.”

It wasn’t always that way. Back in the early months of the Harper government in 2006, reducing wait times featured prominently among the new Prime Minister’s five top priorities. The others—lower taxes, safer streets, better accountability, stronger families—all, arguably, still rank today as major Tory themes. But wait times? After an initial injection of $1 billion—largely to encourage provinces to set “wait-times guarantees” for selected surgeries and health services—the federal government hasn’t followed up with anything significant. “They don’t want to take the political heat for areas that are failing to perform,” says Dr. Howard Ovens, a member of the Canadian Association of Emergency Physicians’ public affairs committee.

His suspicion that Ottawa has retreated because quick access to health services is notoriously hard to guarantee—and voters tend to feel deep frustration over long waits—fits with a certain view of Conservative strategy. Decisive moves were possible on all the other top priorities Harper flagged back in his early days in office. Cut the GST, outlaw corporate and union donations to political parties, impose longer jail time for certain crimes, pay parents $100 a month per kid—easy-to-understand measures such as these were implemented swiftly. Changing the way doctors and hospitals deliver services is far messier, and it’s mainly a provincial responsibility, anyway. Harper, who declines to even meet the premiers as a group, has shown no appetite for tackling problems that would force him to try coaxing them into agreement.

Still, his early work on wait times looked like the beginning of something. Starting in 2007, Harper paid the provinces $612 million over three years to try guaranteeing a reasonable wait for a sample procedure. For instance, British Columbia promised radiation therapy within eight weeks; Newfoundland, bypass surgery within 26 weeks. The money ran out in 2010. Today, the Conservative party’s website doesn’t even mention that short-lived project in a list of 11 actions the government has taken on health, from promoting healthy eating to encouraging doctors to practise in remote areas. There are other signs the Tories aren’t eager to draw attention to any federal role in the most intractable health care problems. The Health Council of Canada, which was set up in 2003 by the then-Liberal government, as part of the follow-up to the Romanow commission on the future of health care in Canada, is shutting down after the Harper government cut off its $6 million a year in funding.

As the council’s head, Abbott is predictably unhappy about winding it up. He argues that the council played a unique role in pressing not only the federal and provincial governments, but also the powerful doctors’ associations and hospital lobby, to take action on sometimes controversial files. For instance, the council urged politicians to pursue a national pharmaceuticals strategy that would give Canadians catastrophic drug coverage—a push the Harper government certainly didn’t welcome. This month, the council is selling off the furniture from its Toronto headquarters. It formally ceases operations at the end of March. Key statistics will continue to be gathered and reported on by the Canadian Institute for Health Information, but the institute doesn’t have the council’s mandate to propose reforms based on those data.

Even though doctors tend to forge closer links to provincial health ministries, their lobby groups often favour the federal government taking on a bigger role. Ovens says there has been some progress in shortening waits over the past decade or so, but success tends to be uneven across the country, sometimes following what he calls a “whack-a-mole” pattern that sees provinces addressing whatever type of surgery or service has most recently drawn negative media attention. When it comes to emergency services, Ovens’s specialty, he argues that the feds are best positioned to set national goals. “There is a coordinating role they could play,” he says, “just bringing everyone together and chairing a forum on how we are going to report this stuff, what we are going to set as the targets.”

Ovens says the federal government could go further than just serving as a coordinator, by requiring provinces to meet targets to qualify for some funding for access to care through emergency departments. The concept of transfer payments tied to performance is contentious. Still, the College of Family Physicians of Canada urged just that in a sweeping 2011 policy paper, calling for new strings to be attached to federal health transfers to the provinces. “Unlike past agreements,” the family physicians’ group said, “these health care funding agreements must include clear accountability provisions, with the requirement that each jurisdiction eligible to receive funds must meet explicitly defined targets.”

Dr. Francine Lemire, chief executive of the College of Family Physicians, says Canadians view health care as part of their shared identity, so they aren’t satisfied with provinces being left alone to set standards. “We believe there’s a need for a federal leadership role,” Lemire says. Ovens argues that, without Ottawa playing an active part, provinces tend to lose sight of each other. “A lot of provinces are making the same mistakes and not learning from each other,” he says. “We’re not asking the feds to start delivering health programs; we’re asking that there be some leadership shown in trying to learn the right lessons from what’s happening provincially and to get us rolling in the right direction.”

But Health Minister Ambrose’s officials defend Health Canada’s record in providing practical help that filters down to the provincial level. They point out that the federal government has provided $900 million since 2006 to what’s called the Canada Health Infoway, to allow provinces and territories to invest in electronic health information and communication technologies, including health records, which are often cited as vital to improving efficiency and cutting wait times. As well, the Canadian Institute for Health Information is getting $239 million in federal funding over three years to keep building up reliable, comparable data about the health care system across the country, including wait times, which also helps health managers pinpoint successes and failures.

Worthy as those initiatives might be, though, they hardly rise to the lofty level that Harper set back in 2006. “In this country, there is a deal between the state and its citizens,” he said in the House that spring, after delivering his ?rst agenda-setting Speech from the Throne. “If they pay their taxes into a public insurance system, they are supposed to get necessary medical treatment when they need it.” He promised “to act right away to make things better and faster.” That $1-billion, three-year payment to provinces for experiments with wait-times guarantees was packaged as fulfilling his commitment. Canadians who caught the news last week that they wait longer than patients in 10 other comparable countries just to see a family doctor might wonder why this particular policy challenge has fallen off the federal radar.

]]>http://www.macleans.ca/news/how-health-wait-times-fell-off-the-harper-governments-radar/feed/21U.S. Surgeon General on smoking: ‘We still have a major and tragic catastrophe going on’http://www.macleans.ca/general/u-s-surgeon-general-on-smoking-we-still-have-a-major-and-tragic-catastrophe-going-on/
http://www.macleans.ca/general/u-s-surgeon-general-on-smoking-we-still-have-a-major-and-tragic-catastrophe-going-on/#commentsFri, 17 Jan 2014 11:40:18 +0000The Associated Presshttp://www2.macleans.ca/?p=455328WASHINGTON – It’s no secret that smoking causes lung cancer. But what about diabetes, rheumatoid arthritis, erectile dysfunction? Fifty years into the war on smoking, scientists still are adding diseases…

WASHINGTON – It’s no secret that smoking causes lung cancer. But what about diabetes, rheumatoid arthritis, erectile dysfunction? Fifty years into the war on smoking, scientists still are adding diseases to the long list of cigarettes’ harms — even as the government struggles to get more people to kick the habit.

A new report from the U.S. Surgeon General’s office says the nation is at a crossroads, celebrating decades of progress against the chief preventable killer but not yet poised to finish the job.

“The real emphasis needs to be put on the fact that we still have a major and tragic catastrophe going on,” said acting Surgeon General Boris Lushniak.

The report, being released Friday, is a dash of cold water after last week’s headlines marking the 50th anniversary of the landmark 1964 surgeon general’s report that launched the anti-smoking movement. Yes, far fewer Americans smoke today — about 18 per cent of adults, down from more than 42 per cent in 1964.

But the government may not meet its goal of dropping that rate to 12 per cent by 2020, the new report cautioned.

Nearly half a million people will die from smoking-related diseases this year. Each day, more than 3,200 youths smoke their first cigarette. New products such as e-cigarettes, with effects that aren’t yet understood, complicate public health messages. And if current trends continue unabated, 5.6 million of today’s children and teens will go on to die prematurely during adulthood because of smoking, the report found.

Remarkably, the report adds more entries to the official list of smoking-caused diseases, including Type 2 diabetes, rheumatoid arthritis, erectile dysfunction, the macular degeneration that can blind older adults, two additional cancers — liver and colorectal — and cleft palate birth defects.

“Enough is enough,” said Lushniak. He urged new resolve to end smoking by increasing use of proven tobacco-control measures, including price hikes for cigarettes and expanding comprehensive indoor-smoking bans that he said currently cover about half the population.

The report also encourages research into newer ideas, such as whether lowering the amount of addictive nicotine in cigarettes would help people quit.

Here are some ways the smoking landscape has changed between the 1964 surgeon general’s report and Friday’s:

___

1964: The surgeon general declares that cigarette smoking increases deaths.

2014: About 20.8 million people in the U.S. have died from smoking-related diseases since then, a toll the report puts at 10 times the number of Americans who have died in all of the nation’s wars combined. Most were smokers or former smokers, but nearly 2.5 million died from heart disease or lung cancer caused by secondhand smoke.

___

1964: Heavy smoking is declared the main cause of lung cancer, at least in men. “The data for women, though less extensive, point in the same direction.”

2014: Today, lung cancer is the top cancer killer, and women who smoke have about the same risk of dying from it as men. As smoking has declined, rates of new lung cancer diagnoses are declining nearly 3 per cent a year among men and about 1 per cent a year among women.

TORONTO – Influenza is notoriously mercurial, forcing even the experts to guess at which strain will dominate from one year to the next. As Canada is learning this winter, almost as unpredictable as the virus itself is whether the public will be willing to embrace flu vaccination.

Public Health officials regularly plead and cajole, but most years the majority of people pass on getting a shot. Canadian flu vaccination rates sit pretty squarely in the one-quarter to one-third range, Statistics Canada data show.

But occasionally we experience a phenomenon such as what has been happening in Western Canada where, undeterred by frigid temperatures, people embarked on sometimes desperate searches for flu shots — something they should have done weeks ago to get optimal protection.

While public health authorities are delighted people want to be vaccinated, they are puzzled by the unexpected clamour for flu shots. Going by the numbers, this year’s flu season is active, but not overly severe.

So what the heck is going on? When it comes to flu shots, why does cool indifference sometimes give way to white hot demand?

“The psychology of influenza vaccination uptake is sometimes almost as complex as the disease itself,” says Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

“We want everyone to be vaccinated. But the question is: Why do we sometimes have these runs?”

So far this year the data collected by the Public Health Agency of Canada and the U.S. Centers for Disease Control suggest North America is experiencing a normal sort of flu season.

Hospitalization rates for influenza, for instance, are lower than those of some recent years. And where 171 children died from flu infections last winter in the United States, so far this year there have been 10 pediatric deaths there.

“I think that this year will assuredly end up less — as far as sheer numbers — than the 2009 pandemic,” says Dr. Michael Jhung, a medical epidemiologist in the CDC’s influenza division.

“And it looks like it will have had less activity than last year, but that I’m not so sure about until we get all the data in.”

But Jhung and others say the overall picture may be masking a shift that the public is actually picking up on. It’s not that more people are getting admitted to hospitals or dying from flu. The concern stems from who is getting severely ill and who is dying.

For years, flu saved its biggest wallop for the elderly. But since the new H1N1 strain emerged in the 2009 pandemic, you can’t assume that grandma and grandpa are the folks most likely to end up in ICUs with flu.

As was seen in the pandemic, the elderly aren’t as susceptible to this H1N1 as they are to H3N2, the virus that dominated last season. Younger people are more likely to get infected with this virus, and some of those infections lead to serious illness.

“We’re used to our parents being the ones who end up in ICU or dying, sadly…. But now it’s us, right?” says Dr. Perry Kendall, chief medical officer of health for British Columbia.

“So if you’re a 50-year-old, you would be sad if your father or your mother went into ICU. But when it’s your spouse or your brother, it’s different. The risk is a lot more proximal.”

By flu terms, the numbers of deaths being reported this year are still small. Two deaths here, 10 there. Each is a tragedy. Still, the reality is lots of people die from flu every year; the Public Health Agency of Canada estimates the toll to be about 3,500 Canadians a year.

But those smaller numbers actually mean something to people, where the larger estimate is an abstraction, suggests Dr. Kumanan Wilson, a senior scientist at the Ottawa Hospital Research Institute.

“A few stories that are particularly vivid and clear can start to create a perception of risk that’s much greater than the actual number of deaths,” he says.

“There’s a big difference between an individual story of a young person who was healthy, got the flu and then died than at the end of the flu season someone saying ‘Actually, X thousand people died from the flu.’”

Jhung says as of last week the U.S. had seen 2,622 hospitalizations. Of those, 61 per cent were in the 18-to-64 demographic. “When we think about who gets hospitalized for flu, it’s usually 60 per cent of those hospitalizations are in people 65 or older.”

In both Canada and the U.S., there are reports of really sick young and middle-aged adults in ICUs. That was the pattern during the H1N1 pandemic, so public health folks who know influenza aren’t surprised. That’s the way this virus rolls.

But it’s not something the public — or even some doctors — expect from flu, Jhung says, admitting this could be making influenza more noticeable this year.

“I do get the sense — and this is not substantiated by any data — that clinicians are being maybe taken aback a little bit by the number of severe illnesses they’re seeing in younger adults.”

The perception something unusual is happening fuels demand for vaccine and supplies start to tighten. Suddenly that shot you didn’t think you needed is something you desperately want, something you and your children need to be safe.

It’s happened before.

In 2004, the U.S. lost about 40 per cent of its vaccine order when one of its suppliers had to jettison its entire output because of a contamination problem. Word that supplies would be tight sent demand soaring. Americans were crossing the border to get a flu shot in Canada. Canada had plenty of vaccine that year, but media coverage of the U.S. shortage spiked demand here too.

And just as Canadian vaccination clinics were poised to open in the 2009 pandemic, a young boy died from the new flu in Ontario. Lines for vaccine were enormous.

The frustrating thing for public health officials is that these periodic runs on flu vaccine do not seem to translate into long-term increases in demand for flu shots. It’s quite probable that many of the people who lined up this week will not bother getting a flu shot next fall.

“It’s a shame that this psychological effect also tends to wane over time,” says Jhung.

“You would think that if they’d never been vaccinated, once they go through the process and recognize that it’s really not that bad, that they may continue to do it. But I don’t know what’s going to make the message stick. We haven’t figured that out yet.”

A colourized transmission electron micrograph of Avian influenza A H5N1 viruses (seen in gold) grown in MDCK cells (seen in green) are shown in this 1997 image. (The Canadian Press)

TORONTO — Canada has reported the first case in North America of an infection with the H5N1 avian flu virus. An Alberta resident who had travelled to Beijing, China in December fell ill and died after returning.

With H1N1 — seasonal flu — making headlines these days, this new development may trigger flu confusion. So here are some essential flu facts:

What is H5N1?

It’s the original “bird flu.” This is the virus that burst out in Asia in late 2003 and early 2004. Millions of poultry died or were culled as the virus — which is highly infectious among birds — spread in Vietnam, Thailand and other countries. It hasn’t been making as many headlines lately, but it’s still causing bird outbreaks and occasional human cases in parts of Asia.

Highly infectious among birds? What about people?

Since late 2003, just under 650 people from 15 — now 16 — countries are known to have contracted this strain of flu. But it rarely infects humans. Untold numbers of people in affected countries would have been exposed to it over the years but very few have gotten sick. And while there have been a few cases where one sick person spread it to others, those chains of transmission have always died out. Unlike human flu viruses, this virus is not an effective person-to-person spreader.

Is it likely the Canadian case will lead to more infections?

Health authorities say there are no signs of illness among of the person’s contacts or the health-care workers who cared for the patient. They’ll need to watch those people for a couple of weeks to make sure. But this could be a one-off case.

So what’s the fuss about?

The virus doesn’t spread person to person now. But science can’t tell if it will evolve and acquire the capacity to spread human to human. So flu experts and the World Health Organization watch this virus closely. Also, about 60 per cent of people who have been known to have been infected have died. So while infections are rare, they’re often severe.

Does a flu shot protect against H5N1?

No. The seasonal flu vaccine protects against the human flu viruses that circulate every winter. Some manufacturers have made experimental H5N1 vaccines for testing purposes, but there is no H5N1 vaccine available for the public at this moment.

Is H5N1 related to H1N1, the virus we’re hearing so much about this winter?

All flu viruses have the same original source; they come from wild water birds like ducks. But some have found their way into animals — pigs, horses, dogs — and spread among them. And some have become human flu viruses: H1N1, H3N2 and influenza B viruses.

Human viruses? Bird viruses? What’s the difference?

Our immune systems have some experience with the seasonal viruses. From childhood, we’ve been infected sporadically throughout our lives. But animal or bird flu viruses look different enough genetically that our immune systems don’t mount the kinds of response they do for regular flu. More people would be susceptible to them, so if they start to spread among people they can set off a huge wave of illness, called a pandemic. That happened in 2009 when a swine influenza virus, H1N1, started infecting people.

]]>http://www.macleans.ca/news/canada/explainer-what-you-need-to-know-about-h5n1/feed/1Fatal case of H5N1 bird flu reported in Alberta, first North American casehttp://www.macleans.ca/news/canada/fatal-case-of-h5n1-bird-flu-reported-in-alberta-first-north-american-case/
http://www.macleans.ca/news/canada/fatal-case-of-h5n1-bird-flu-reported-in-alberta-first-north-american-case/#commentsThu, 09 Jan 2014 11:56:31 +0000The Canadian Presshttp://www2.macleans.ca/?p=453198OTTAWA – Canada has reported North America’s first case of H5N1 bird flu infection, in an Alberta resident who recently returned from a month’s visit to China.
The person, whose…

OTTAWA – Canada has reported North America’s first case of H5N1 bird flu infection, in an Alberta resident who recently returned from a month’s visit to China.

The person, whose name and age were not revealed, was reportedly feeling ill on Dec. 27 while flying from Beijing to Vancouver and then on to Edmonton. The patient was admitted to hospital on Jan. 1 and died Jan. 3.

Federal public health officials said confirmation of the rare exported H5N1 infection was made Tuesday evening and Canada informed officials of the World Health Organization on Wednesday.

Health Minister Rona Ambrose, who took part in a hastily assembled news conference in Ottawa, said the case is likely to be an isolated one.

“The risk of getting H5N1 is very low,” Ambrose said. “This case is not part of the seasonal flu, which circulates in Canada every year.”

The discovery of a case of H5N1 so far afield was already garnering international attention Wednesday. But flu experts said that in some ways, the novelty isn’t that a case was found here, it was that such an event hadn’t happened sooner.

“I’m surprised we haven’t seen at least one importation before now into North America … given the connectedness that we have with that region,” said Dr. Danuta Skowronski, an influenza expert at the British Columbia Centre for Disease Control

“We’ve been preparing for an incursion for over a decade,” acknowledged Dr. Theresa Tam, head of the Public Health Agency of Canada’s health security infrastructure branch.

“It’s actually much rarer than we had ever thought. This is the first case in this whole continent.”

Officials did not release the name of the patient, nor did they indicate how old the person was, where he or she lived in Alberta or whether the person is a he or a she. During the news conference, the term “she” was used several times, but it wasn’t clear if that was a slip and officials insisted they would not confirm the person’s gender.

Contacts of the Alberta resident, as well as the health-care workers who cared for the patient, are being monitored for signs of illness but to date there does not appear to have been onward transmission of the virus. They have been offered the antiviral drug Tamiflu, which can be taken to prevent infection as well as to treat it.

“None of them have symptoms and the risk of developing symptoms is extremely low,” said Dr. James Talbot, Alberta’s chief medical officer of health. “Precautions for health-care staff were also taken as part of this individual’s hospital treatment.”

The Public Health Agency will be contacting passengers who were on the same flights as the Alberta traveller to check on their health. But Dr. Gregory Taylor, Canada’s deputy chief public health officer, said it was unlikely transmission occurred on the planes.

The person travelled on Air Canada flight 030 from Beijing to Vancouver, and Air Canada 244 from Vancouver to Edmonton. Both flights were on Dec. 27.

Dr. Perry Kendall, British Columbia’s chief medical officer, said the person spent about two and a half hours in Vancouver International Airport waiting for the connecting flight and was there from about 12:30 p.m. PST to 3 p.m. PST. He too suggested it was unlikely that the infected person transmitted the virus to others en route.

In fact, flu experts were viewing the event as interesting, and a useful reminder that international travel can spread infectious diseases around the globe. But they weren’t unduly concerned.

“Every H5N1 case makes you nervous. But I don’t think it should be a cause for alarm,” said Dr. Allison McGeer, head of infection control at Toronto’s Mount Sinai Hospital.

“It’s good that people are watching for it. Brilliant that people identified the issue and made the diagnosis.”

Figuring out what was behind the illness wasn’t easy.

The patient had what is being described as an atypical presentation — fever and headache, which are symptoms of flu, but no cough, which is common in influenza cases.

The person went to hospital on Dec. 28 but was sent home after being examined. The illness progressed rapidly and the person returned to hospital on Jan. 1 and was admitted. On Jan. 3, he or she died.

In an interview with The Canadian Press, Taylor said initially it was thought the person had a clot in the lung — a pulmonary embolism — but that was ruled out. And after the first visit to hospital by the person, on Dec. 28, the patient was sent home.

The health-care team caring for the patient also thought the person might have meningococcal encephalitis, an infection of the brain.

But a chest X-ray showed signs of pneumonia and the unidentified hospital ran a battery of tests. The influenza A test came back positive, as did one for a human coronavirus, one of the causes of common colds. The team wondered for a time if the severity of the illness was due to the co-infection with two viruses.

On Jan. 5, Taylor received a call from Talbot, who said tests showed the flu virus was not one of the seasonal influenza A viruses. Alberta was going to send a sample to the National Microbiology Laboratory in Winnipeg to get their help.

The specimen arrived in Winnipeg on Tuesday morning. By that evening the Alberta lab had identified the virus as an H5; it didn’t have the capacity to identify which neuraminidase or “N” number the virus had. Almost simultaneously, the Winnipeg lab’s testing got the full result: H5N1.

Tam said the national lab will share the virus with the WHO’s network of influenza collaborating laboratories, but Canada is certain of the test result.

“We’re very confident this is the diagnosis,” she said.

Taylor said the Public Health Agency is also liaising with China and hopes to investigate with it how and where the person was exposed to H5N1. It is currently thought the person did not travel outside Beijing, where there have been no recent reports of H5N1, in birds or in people.

The virus is endemic, though, in parts of the country and continues to spread in a number of countries in Asia and the Middle East.

This virus was first spotted in 1997, in an outbreak in which 18 cases — six of them fatal — were reported. But after that flare up was contained the virus appeared to vanish.

It returned with a vengeance in early 2004, igniting a large multi-country outbreak that continues to this day. Since then nearly 650 human cases have been reported from now 16 countries.

While the virus does not often transmit to people, it can cause severe illness when it does. About 60 per cent of known cases have died from their infections.

]]>http://www.macleans.ca/news/canada/fatal-case-of-h5n1-bird-flu-reported-in-alberta-first-north-american-case/feed/1After years of study, FDA says it has no evidence anti-bacterial soaps curb spread of bacteriahttp://www.macleans.ca/general/after-years-of-study-fda-says-it-has-no-evidence-anti-bacterial-soaps-curb-spread-of-bacteria/
http://www.macleans.ca/general/after-years-of-study-fda-says-it-has-no-evidence-anti-bacterial-soaps-curb-spread-of-bacteria/#commentsTue, 17 Dec 2013 13:35:15 +0000The Associated Presshttp://www2.macleans.ca/?p=449456WASHINGTON – After more than 40 years of study, the U.S. government says it has found no evidence that common anti-bacterial soaps prevent the spread of germs, and regulators want…

WASHINGTON – After more than 40 years of study, the U.S. government says it has found no evidence that common anti-bacterial soaps prevent the spread of germs, and regulators want the makers of Dawn, Dial and other household staples to prove that their products do not pose health risks to consumers.

Scientists at the Food and Drug Administration announced Monday that they are revisiting the safety of triclosan and other sanitizing agents found in soap in countless kitchens and bathrooms. Recent studies suggest triclosan and similar substances can interfere with hormone levels in lab animals and spur the growth of drug-resistant bacteria.

The government’s preliminary ruling lends new support to outside researchers who have long argued that the chemicals are, at best, ineffective and at worst, a threat to public health.

“The FDA is finally making a judgment call here and asking industry to show us that these products are better than soap and water, and the data don’t substantiate that,” said Stuart Levy of the Tufts University School of Medicine.

While the rule only applies to personal hygiene products, it has implications for a broader $1 billion industry that includes thousands of anti-bacterial products, including kitchen knives, toys, pacifiers and toothpaste. Over the last 20 years, companies have added triclosan and other cleaners to thousands of household products, touting their germ-killing benefits.

Under a proposed rule released Monday, the agency will require manufacturers to prove that anti-bacterial soaps are safe and more effective than plain soap and water. Products that are not shown to be safe and effective by late 2016 would have to be reformulated, relabeled or removed from the market.

“I suspect there are a lot of consumers who assume that by using an anti-bacterial soap product, they are protecting themselves from illness, protecting their families,” said Sandra Kweder, deputy director in the FDA’s drug centre. “But we don’t have any evidence that that is really the case over simple soap and water.”

A spokesman for the cleaning product industry said the FDA already has “a wealth of data” showing the benefits of anti-bacterial products.

Monday’s action affects virtually all soap products labeled anti-bacterial, including popular brands from CVS, Bath and Body Works, Ajax and many other companies.

The rule does not apply to hand sanitizers, most of which use alcohol rather than anti-bacterial chemicals.

An FDA analysis estimates it will cost companies $112.2 million to $368.8 million to comply with the new regulations, including reformulating some products and removing marketing claims from others.

The agency will accept data from companies and researchers for one year before beginning to finalize the rule.

The proposal comes more than four decades after the FDA began evaluating triclosan, triclocarban and similar ingredients. The government only agreed to publish its findings after a three-year legal battle with the Natural Resources Defence Council, an environmental group that accused the FDA of delaying action on potentially dangerous chemicals.

Triclosan is found in an estimated 75 per cent of anti-bacterial liquid soaps and body washes in the U.S. More than 93 per cent of anti-bacterial bar soaps also contain triclosan or triclocarban, according to the FDA.

Some consumers said the FDA ruling would have little effect on their buying habits, since they already avoid anti-bacterial soaps and scrubs.

“The regular soap works fine for me. And if I was to think about it, I would guess that those anti-bacterial soaps probably have more toxins,” said Marco Cegarra, of Fort Lauderdale, Fla.

Diane McLean, of Washington, D.C., thought the soaps always “seemed like a bad idea” because of concerns about creating drug-resistant bacteria.

The FDA was asked to investigate anti-bacterial chemicals in 1972 as part of a law designed to set guidelines for dozens of common cleaners. But the guidelines got bogged down in years of regulatory delays and missed deadlines. The agency published a preliminary draft of its findings in 1978, but never finalized the results until Monday.

Most of the research surrounding triclosan’s safety involves laboratory animals, including studies in rats that showed changes in testosterone, estrogen and thyroid hormones. Some scientists worry that such changes in humans could raise the risk of infertility, early puberty and even cancer.

FDA scientists stressed Monday that such studies are not necessarily applicable to humans, but the agency is reviewing their implications.

On a conference call with journalists, Kweder noted that the government’s National Toxicology Program is already studying whether daily skin exposure to hormone-altering chemicals could lead to cancer.

Other experts are concerned that routine use of anti-bacterial chemicals such as triclosan contributes to the emergence of drug-resistant germs, or superbugs, that render antibiotics ineffective.

In March 2010, the European Union banned the chemical from all products that come into contact with food, such as containers and silverware.

A spokesman for the American Cleaning Institute, a soap cleaning product trade organization, said the group will submit new data to regulators, including studies showing that company products do not lead to antibiotic resistance.

“We are perplexed that the agency would suggest there is no evidence that anti-bacterial soaps are beneficial,” said Brian Sansoni. “Our industry sent the FDA in-depth data in 2008 showing that anti-bacterial soaps are more effective in killing germs when compared with non-anti-bacterial soaps.”

The group represents manufacturers including Henkel, Unilever and Dow Chemical Co.

]]>http://www.macleans.ca/general/after-years-of-study-fda-says-it-has-no-evidence-anti-bacterial-soaps-curb-spread-of-bacteria/feed/5First, they came for the cigarettes…http://www.macleans.ca/education/uniandcollege/first-they-came-for-the-cigarettes/
http://www.macleans.ca/education/uniandcollege/first-they-came-for-the-cigarettes/#commentsFri, 06 Dec 2013 19:08:41 +0000Todd Pettigrewhttp://oncampus.macleans.ca/education/?p=61508Now some students want to ban energy drinks.

As part of a class project, a group of students at the Antigonish university want Red Bull and friends booted into the Strait of Canso because it is, they maintain, inconsistent with a healthy lifestyle.

Sadly, such a proposal is in keeping with the recent trend towards unbridled self-righteousness when it comes to health. We have long since moved past encouraging people to eat well and get plenty of exercise. Today, maintaining a healthy lifestyle is approached as though it were a moral issue. An unhealthy choice, it now seems, is not only potentially unwise — it must be stopped.

But energy drinks are not monsters. Not even the one actually called Monster. Sure, they contain caffeine, but a can of Rockstar — my personal favourite — contains around 80 mg of caffeine. According to this data provided by the Mayo Clinic, that’s considerably less than an ordinary cup of coffee, and just over half of what’s in a Starbucks Latte. And some may be loaded with sugar, but a lot of people like sugar. It’s really catching on. And, believe it or not, there are other goods in the world besides health. Pleasure is one. And so is freedom. And so is a boost of energy when your term paper is almost due.

In a free society, banning anything (even in a limited area like a university) should come as a last resort and be reserved for only the most serious of dangers. Deadly toxins. Guns. Powerful explosives. A can of Amp doesn’t qualify.

TORONTO – A drug used to treat advanced breast and colorectal cancers has been linked to potentially fatal skin reactions in some patients, says the medication’s manufacturer in an advisory from Health Canada.

Hoffmann-La Roche Ltd. said Tuesday that severe skin reactions have been reported in patients taking the drug Xeloda.

Xeloda is used to treat advanced breast cancer or breast cancer that has spread to other parts of the body, as well as metastatic colorectal cancer and cancer of the colon following surgical removal.

Severe skin reactions such as Stevens–Johnson syndrome and toxic epidermal necrolysis, in some cases with a fatal outcome, have been reported during treatment with Xeloda, the company said.

Signs and symptoms of severe skin reactions may include flu-like symptoms, fever, skin itching and a painful, red or purplish skin rash that spreads and blisters, causing the skin to shed. Other possible symptoms include mouth sores, eye burning, itching and discharge.

Patients who develop any of these symptoms should contact their health-care professional immediately, Hoffmann-La Roche said.

]]>http://www.macleans.ca/general/potentially-fatal-skin-reactions-linked-to-cancer-drug-xeloda-health-canada/feed/0Saint Mary’s nurse tired of excuse noteshttp://www.macleans.ca/education/uniandcollege/saint-marys-nurse-tired-of-excuse-notes/
http://www.macleans.ca/education/uniandcollege/saint-marys-nurse-tired-of-excuse-notes/#commentsThu, 21 Nov 2013 20:02:22 +0000Josh Dehaashttp://oncampus.macleans.ca/education/?p=60995Professors clog up clinic with students who may not be ill

Jane Collins is a very dedicated campus nurse. So dedicated, in fact, that she offers her cell phone number to students at Saint Mary’s University in Halifax so she can advise them after hours. She picked up on the first ring when Maclean’s On Campus called to find out whether she’d really stopped writing sick notes for those who show up to the campus health clinic, as reported by CBC.

She hasn’t entirely but says that, after 19 years on the job, she’s fed up that professors still ask students to get excuse notes for missed midterms, which is often a waste of time. The registrar has twice asked deans to pass that message along to professors but it’s not getting through.

In the busy post-midterm period, she has had to book off an hour a day just to write sick notes.

“Students I’m seeing come in saying, ‘I was sick two or three weeks ago and if you don’t give me a note I’m going to fail my [mid-term] exam,’” she says, “putting it all on my shoulders.”

“I wrote a note for one this morning,” she says, referring to a repeat customer who came in three times with the same seemingly-fixable complaint, which she said occurred 10 days ago. All Collins wrote was, “student states that she was ill; she was not seen at student health.” How useful is that?

“I’ll have students call me late at night and say, ‘I’ve been throwing up all night, I have an exam tomorrow, can you write me a note?’” she says. “I’m thinking, well, I don’t want to be too jaded but I have no way to know you’re throwing up. I can’t ask you to bring in a sample of vomit.”

She doesn’t want students with stomach flu coming in anyway, as they might infect others.

Collins emphasizes there are legitimately sick people who have documented anxiety or depression with campus counseling and she’s happy to write them notes. Others may be referred to doctors. For now though, many will be sent off-campus to walk-in clinics, which charge for sick notes.

She’s hoping to spark a change of culture on campus.

“It all comes down to the professor being responsible and saying, ‘you missed an exam, here’s a make-up,’” she says, “or the student studying even though they have three exams in two days.”

]]>http://www.macleans.ca/education/uniandcollege/saint-marys-nurse-tired-of-excuse-notes/feed/8Bring on that extra hour of shut eyehttp://www.macleans.ca/society/life/bring-on-that-extra-hour-of-shut-eye/
http://www.macleans.ca/society/life/bring-on-that-extra-hour-of-shut-eye/#commentsSat, 02 Nov 2013 09:40:17 +0000The Canadian Presshttp://www2.macleans.ca/?p=437464Why the fall back to standard time is good for your body

TORONTO – Canadians who hope to keep their lives running like clockwork in the coming days should feel free to trust their bodies more than their time pieces, experts say.

Most of the country is preparing to fall back to standard time by adjusting clocks an hour earlier on Sunday morning.

In an age of increasing automation, however, experts predict many may find themselves overlooking the annual chance to grab an extra hour of shuteye.

Cellphones, tablets and computers all update their internal clocks automatically, as do most devices connected to satellite.

Those Canadians that no longer have to go through the hassle of adjusting time pieces by hand may find themselves overlooking the time change and relying on their internal clocks to keep them in step with the rest of the world.

Fortunately, said Queen’s University sleep researcher Judith Davidson, the human body is usually up to the task of helping people make the transition at this time of year.

The human biological clock runs slightly longer than one day, she said, adding the average circadian rhythm is 24.2 hours.

Moving schedules back by an hour, she said, comes far more naturally than the process of moving to daylight time in the spring.

“Because it’s a bit longer than 24 hours, we naturally tend to drift later if anything,” Davidson said in a telephone interview.

“If we have to shift one way or another, this is the most natural direction to shift.”

Heeding those biological rhythms will give most Canadians a lot of options as to how they spend their extra hour, Davidson said.

Sleep experts urge Canadians to prepare for the spring time change by adjusting sleep and wake times, but Davidson’s advice for the fall version is to simply go with the flow.

“We might as well just enjoy this opportunity to stay up late if we want to, knowing we don’t have to race out of bed in the morning, that we will be able to get up and it will be the right time . . . biologically,” she said.

Davidson cautioned, however, that one group of Canadians may find the time change more of a trial than a treat.

People who suffer from insomnia may find the additional 60 minutes drags down a time of day they’ve already come to dread.

Davidson urged those people to spent that time doing anything except tossing and turning in bed, adding waiting fruitlessly for slumber is a sure way to disrupt an already tenuous routine.

Clocks fall back at 2 a.m. on Sunday except in most of Saskatchewan as well as parts of Quebec, Ontario and British Columbia.

When you see a sexual health study sponsored by a condom company you may be skeptical, especially when the headline is that 51 per cent of students who had sex last year didn’t use a condom. Half? Really? It sounds like a ploy by Trojan—which commissioned the survey of 1,500 undergraduates in partnership with the Sex Information and Education Council of Canada—to sell more rubbers. After all, this generation grew up with non-stop public health education on the risks of a sexually transmitted infections like HIV. Students couldn’t possibly be so careless, right?

Unfortunately, I’ve seen this number before. Canadian results from the National College Health Assessment, a survey filled out by 34,039 students at 32 Canadian schools earlier this year, also found that only half of students use condoms most or all of the times they have vaginal sex.

That NCHA report also showed that one in 100 had been treated for Chlamydia in the previous year, which if extrapolated to the roughly one million undergraduates in Canada is about 10,000 cases. Chlamydia is not fun but also not deadly. HIV-AIDS, on the other hand, is incurable. About one in 500 students reported being treated for HIV-AIDS, suggesting about 2,000 known cases.

Despite these risks, the Trojan/SIECANN study found that more than half (56 per cent) of students say they are not very concerned about sexually transmitted infections. And 23 per cent think there is a vaccine to prevent HIV while 21 per cent think there might be one. There certainly isn’t.

To recap: roughly half of students are so unconcerned and uneducated about STIs that they don’t know that there isn’t an HIV vaccine, they don’t use condoms and they don’t worry much about STIs. It looks like the main message of sex education still isn’t getting through.

“It is estimated that mental illness costs the economy more than $50 billion a year.” This is the kind of sentence you might encounter in any old issue of a newspaper, though it’s actually from the Oct. 13 Globe and Mail. When I say you would encounter it, I am not suggesting you would read it. It’s the kind of claim we are so used to encountering in the press that the eye slides right past it. We don’t usually sit down and think about what $50 billion literally means, contrasted with $1 billion or $500 billion. In the context of a news story mongering war against some social ill or disease category, all such numbers are simply read as “a huge amount.”

The annual gross domestic product of the country is about $1.8 trillion, with human labour’s share being about half. So the figure of $50 billion, which comes from a study issued earlier this year by the Mental Health Commission of Canada, represents a loss of about 5.5 per cent in the potential annual output of Canadian workers. Is this a realistic number? Is it in the nature, let us stop to ask for once, of a true assertion?

It is realistic in the sense of resulting from a conservative calculation. When one probes social-cost claims made by do-gooders, they often turn out to incorporate laughable or downright dumb assumptions. When a politician screams about the costs of smoking, you can be sure he is always including every dime of hospital costs for lung-cancer treatment, and never subtracting the years of senior care and pension payments saved by the public-spirited unhealthy.

But mental illness doesn’t have apparent benefits that need to be weighed in the balance, and 5.5 per cent is pretty reasonable on its face. You know plenty of people whose incomes are 20 per cent, or 100 per cent, less than they might be because of mental or emotional disorders. The commission’s actual report calculates that we spend $29 billion a year directly on care for the mentally ill, so that is the bulk of the $50 billion right there. Another $21 billion in lost productivity does not seem like a lot to ask of our credulity.

The real problem is what we mean by “lost productivity.” What is being postulated here is a sad, spiritually afflicted populace whose “economy” could be bigger if absolutely everyone were well enough to work to their full capacity. We all sacrifice some part of “the economy” to personal happiness or to the well-being of our families and loved ones. Probably we all sacrifice some to personal pathologies, whether or not they could be characterized as mental illnesses. Is being somewhat lazy a mental illness? How about having an IQ of 88? “Costs to the economy” are, in this sense, hard to take seriously: human imperfections defy accounting.

When it comes to mental illness, the incremental loss “to the economy” of diminished human productivity is only relevant to policy to the degree that it could be corrected at no compensating expense. Otherwise, cost claims amount to the difference in earnings between ourselves and hypothetical, perfectly rational gods. The irony of mental health advocates waving the $50 billion figure around is that they explicitly want to increase it by pouring more money into public mental-health programs. Give them $100 billion more and they would quickly be using that in their argument for the next $100 billion.

If the economy, rather than humanity, is the relevant guiding principle here, it might make more sense to ask what, if anything, the $29 billion a year we already spend gets us. Schizophrenia, to take perhaps the most horrendous single form of mental illness, is still a “disease” with constantly shifting diagnostic criteria, a hundred etiological theories, no biological test and an array of drug therapies that work well for the exceedingly few people who will stick to them reliably. The Globe story advocates a “social movement that will . . . do for mental health” what other foundations have done for cancer and heart disease. Is it gauche to observe that doctors can actually cure some cancers, and that there are strong validated treatments for heart disease?

We treat the mentally ill in the name of hope, not GDP. The Mental Health Commission’s $50-billion figure is really nothing but attention-getting ad copy. It does not seem to have been torqued upward by use of sleazy mathematical assumptions—but it could have been, if the original number were not impressive enough, and it is not as though anybody would check. So what’s it doing in a newspaper anyway?

On the web: For more Colby Cosh, visit his blog at macleans.ca/colbycosh

NEW YORK, N.Y. – Diet Coke, the country’s No. 2 soda, may be losing some of its pop.

During a conference call with analysts Tuesday, a Coca-Cola executive noted that Diet Coke was “under a bit of pressure” because of people’s concerns over its ingredients, alluding to the growing wariness of artificial sweeteners in recent years.

Steve Cahillane, who heads Coca-Cola’s North American and Latin American business, noted that the issue wasn’t specific to Diet Coke, but that many diet foods and drinks in the U.S. are facing the same concerns.

“We believe very strongly in the future of Diet Coke,” Cahillane stressed, noting that the drink was still the No. 2 soda in the U.S, after knocking Pepsi from that perch in 2010. The company still sells twice as much regular Coke as Diet Coke.

Cahillane also noted that the company is investing in boosting Diet Coke’s performance, pointing to recent promotions with singer Taylor Swift as an example.

Soda has been under fire from health advocates for several years now, and Americans have been cutting back on sugary fizz for some time. But in a somewhat newer development, diet sodas are falling at a faster rate than regular sodas, according to Beverage Digest, an industry tracker.

Those figures aren’t going unnoticed in Coca-Cola’s Atlanta headquarters. This summer, the company launched its first ad addressing the safety of aspartame to ease concerns people might have. It has also distributed fact sheets on the topic to its bottlers and retailers who sell Coke products.

The Food and Drug Administration says aspartame may be safely used in foods as a sweetener, and the American Cancer Society has said that most studies using people have found that aspartame is not linked to an increased risk of cancer.

Still, the broader trend in the U.S. has been toward foods and drinks people feel are natural or organic. And Coca-Cola is clearly aware of the shift; the company is working on producing sodas made with natural, low-calorie sweeteners. It also launched a version of its namesake drink sweetened with stevia in Argentina this summer. Stevia comes from a plant of the same name.

Meanwhile, Coca-Cola Co. said that sales volume for regular, full-calorie Coke rose 2 per cent in North America in its latest quarterly results reported on Tuesday. Coke Zero, which is made with artificial sweeteners and targeted more toward men, rose 5 per cent.

The company didn’t break out Diet Coke’s performance, but overall soda volume for the region was flat.

TORONTO – The findings are startling, given years of complaints about doctor shortages and long wait times for surgeries. But a new report suggests that nearly one in six recently minted medical specialists cannot find work in their field.

And one in five of the new specialists reported taking a series of short term fill-in posts — locums, in the lingo of medicine — to stay working.

Physicians who reported having trouble finding work included urologists, critical care specialists, gastroenterologists, ophthamologists, orthopedic surgeons and general surgeons, though doctors from other sub-specialties were also unemployed.

Steven Lewis, a health policy consultant based in Saskatchewan, suggested the report is proof reactive moves made over the last 15 years or so solved one problem by creating another. And he said the situation the report captures will only get worse, because medical schools will continue to graduate specialists at current levels for the next few years at least.

“I think we overshot the mark,” said Lewis, who was not involved in this study.

“I think that there is no question that … almost doubling medical school enrolments since the late 1990s combined with easier paths to licensure for international medical grads was the wrong thing to do. We didn’t think it through as a country.”

The study was conducted for and released by the Royal College of Physicians and Surgeons. The principal investigator was Danielle Frechette, executive director for health systems innovation for the college.

Frechette said the organization, which sets standards for physician education in the country, had been hearing anecdotes about rising numbers of unemployed doctors, so decided to assess the situation.

The ensuing report, released Thursday, is based on a survey of over 4,000 newly graduated doctors and interviews with about 50 people knowledgeable about the situation — deans of medical schools, hospital CEOs and the like.

The report paints a grim picture but does not recommend ways to fix it; that was not the mandate. The Royal College of Physicians and Surgeons is convening a national summit in February to explore ideas for developing a co-ordinated approach to planning health system workforce needs, Frechette said.

She noted a fix will not be easy.

“We’re hoping that our research shows that this is not a simple issue. And that we shouldn’t have any knee-jerk reactions, otherwise we will perpetuate this boom-bust cycle that we’ve been in. It’s like Groundhog Day,” she said, referring to the popular Bill Murray movie.

Frechette suggested, however, that a national health systems workforce planning body would be an important start. Australia, Britain and the U.S. all have such an entity.

The report pointed to a number of factors that have contributed to the oversupply of specialists. Poor stock market returns in recent years have meant that some older doctors — most of whom must finance their own pension plans — have delayed retirement.

And there has been a realignment or rationalization of tasks in health care, with nurses and physician assistants taking on responsibilities that were once left to doctors, freeing them up to do some tasks that used to fall to specialists.

That effect, which Lewis called sensible, will only accelerate as less invasive treatments are brought on line. For instance, angioplasty — opening blocked cardiac arteries with balloons and stents — has replaced many open heart surgeries to bypass blocked arteries.

Lewis suggested the cycle of training specialists — which typically takes about nine years — is out of sync with the cycle of assessing future medical system requirements.

“Forecasting health human resource needs more than three or four or five years out is a fool’s game, because medical science changes, health needs can change, technology can change and so on.”

But Frechette said there are some low hanging fruit — problems that should be relatively easy to address. For instance, her study noted there are jobs going for the asking. And yet while it seems inconceivable in the era of Craigslist and LinkedIn, doctors are having a hard time finding these “help wanted” ads.

“Our research did discover that there are a lot of people who can’t find jobs, including orthopedic surgeons who would gladly go to where the jobs are, but they don’t know where they are,” she said.

Lewis said there are some other adjustments the system should consider. One is shortening the period of time it takes to train a specialist, which would allow planners to adjust the course more quickly if it appeared that a glut of doctors was forming.

“If your whole life is going to be doing hip and knee replacements, I think one can question whether it should take nine years of training,” he said.

Another suggestion involves sharing the wealth. He said it isn’t uncommon to hear of small communities where patients have to wait to see a specialist — but the three specialists in town aren’t keen to let a fourth hang a shingle.

“I think the one thing that’s clear is there won’t be a spontaneous solution that employs all of these new doctors effectively. Somebody has to make room for them,” Lewis said.

“And there have to be some policy and practice changes that will make sure that the vast majority of the new entrants find a useful home in the system without driving up system costs unreasonably.”

REGINA – The University of Regina says it has put hundreds of people at risk due to years of improper blood testing.

The university has issued a warning to more than 260 people who had “blood lactate level testing” done as part of kinesiology and health studies courses.

A nine-month audit found that between 2006 and 2012 an improper testing procedure was used on students during testing in second- and third-year exercise physiology classes, on volunteers participating in research projects, and with “fee for service” clients.

The head of the program, Dr. Harold Riemer, says the risk of blood-borne infections is very low, but the school doesn’t want to take any chances.

A letter to past and present students who may have been affected says potential risks of exposure to HIV, hepatitis C and B ranges from a one in ten million chance of contracting HIV to a six in one million chance of catching hepatitis B.

In all, 267 people took the test during the six years, but their names were not catalogued, so the school is sending out 644 letters to past and present students to make sure everyone is reached.

“We should have been doing our jobs better,” Riemer said in a news release Wednesday.

“We should have been more alert to keep our testing standards up-to-date. I want to apologize to everyone involved and assure them that we will do whatever is needed to make the situation right.”

Dr. Maurice Hennick, the deputy medical health officer with the Regina Qu’appelle Health Region, said he agrees that everyone should be informed.

The procedure in question involved an instrument used to prick the finger of subjects to draw blood.

The lancet that pierced the skin was replaced with each patient but the holder part of the device was reused after being wiped with alcohol. The school says that once it learned that procedure was not up to current standards, processes were changed immediately.

OTTAWA – Federal health officials have expanded a burger recall first announced last week due to possible E.coli O157:H7 contamination.

The Canadian Food Inspection Agency recall initially involved Compliments brand Super 8 Beef Burgers sold in packages of six in Ontario and Atlantic Canada.

The recall now includes the same brand of burger sold in Ontario in Sobeys, Sobeys Urban, Foodland, Freshco and Price Chopper stores.

President‘s Choice Beef Burgers in 4.54 kilogram packages in Loblaws banner stores and Webers Bucket of Burgers sold in 1.02 kilogram packages, also sold nationally, are also being recalled.

The CFIA said Toronto-based Belmont Meats Ltd. was voluntarily recalling the affected burgers and cautions that the recall may be expanded further.

After the initial recall was announced, health officials in southwestern Ontario said lab tests linked three cases of E. coli O157:H7 to the Compliments burgers. The Middlesex-London Health Unit said the three residents of London, Ont., were recovering.

Food contaminated with E. coli O157:H7 may not look or smell spoiled but may cause serious and potentially life-threatening illnesses.

Anyone showing signs or symptoms of E. coli O157:H7 infection, in particular stomach pain and severe or bloody diarrhea, should contact their doctor.

As an ecological field researcher with British Columbia’s Ministry of Forests, Sonya Powell had a dependable, though segmented, career. Seasonal contracts put her in the woods each summer, surveying tree life for $20 to $25 an hour; in the winters, she taught geography classes at the University of British Columbia (UBC). Gaps between jobs were her vacation time, she chuckles.

That was before the global economic downturn led to the collapse of the forestry sector. In the summer of 2009, Powell couldn’t find her usual contracts. Remembering the health problems of the isolated communities she had passed through in the summers, she enrolled in an accelerated 20-month nursing program at UBC designed for students in their second careers. It paid off: She landed not one, but two nursing jobs when she graduated.

“I started almost the next day,” says the 36-year-old, who now works full-time at one of them, the safe-injection centre Insite, in Vancouver’s Downtown Eastside. There, she does immunizations, screens patients and is mentoring a nursing student. “I really love my job,” she says. It also happens to pay around $31 an hour—far more than she earned in forestry.

As Canada’s resource jobs recover from the slowdown, health care appears to be one of the rare recession-proof industries where employment is virtually guaranteed for new grads.

Over the past two years, health care has been among the biggest drivers of job growth. Jobs in the health care and social assistance sectors were up seven per cent (representing 93,000 new positions). That pace will only quicken as Canada’s population ages. Nurses, support staff and therapists are all expected to be in demand.

More doctors were licensed in Ontario in 2012 than ever before—4,149 new registrations, four per cent more than in 2011, according to the College of Physicians and Surgeons of Ontario. In the U.S., since the start of the recession, the story is much the same: The health sector has added 1.4 million jobs, while overall employment has fallen by 5.6 million jobs.

Greying demographics are leading the surge. “Our population is getting older, living longer,” says Monica Parry, director of nurse practitioner programs at the University of Toronto’s faculty of nursing. “Someone might have diabetes, but now that they’re getting older, they also have lung disease or kidney disease. So the average patient is much more complicated to care for than they used to be 10 to 15 years ago.”

At the same time, the health care industry’s own workforce is aging fast, putting pressure on the labour supply. It is estimated that one in five active physicians in Ontario is over the age of 60, according to numbers released in December 2012 by Working in Canada, a job portal run by the federal government. By 2020, nearly 9,000 nurses with a median salary of $72,000 will be retiring every year.

For these reasons, health care and supportive care are excellent choices for those entering the job market. What kind of health jobs are on the rise? Nearly all of them, according to Working in Canada, which shows that everything from family physician to personal care assistant has above-average growth projections across all regions.

A major trend driving health care job creation in 2013 is the continuing push to care for patients in the home, rather than in the hospital. “The whole shuffle is toward providing services in the community,” says Parry. “We used to keep patients in the hospital longer. Now we send them out sooner, so you need the support through resources to manage when people go home.” The roster of health care workers needed to support this shift is huge. It encompasses personal care assistants, who might help a patient with limited mobility bathe or buy groceries, as well as diabetic educators, who work in communities to help diabetics manage their conditions.

The need for these supportive roles for a less institutionalized population of patients has meant a multiplication of routes into the health care sector. A diabetic educator is a registered nurse who has earned another certificate, while a personal care assistant merely needs a college diploma or certificate to provide what is often life-changing care for elderly patients or those with chronic conditions that keep them homebound.

Demand is especially high in under-serviced remote and rural communities, according to Employment and Social Development Canada. To meet the need, in April 2013, the federal government designated more than 4,200 rural communities across the country in which family doctors, nurses, nurse practitioners and family medicine residents could apply for Canada Student Loan forgiveness of up to $20,000 for nurses and $40,000 for doctors.

A position that continues to become more prominent is the nurse practitioner, an advanced class of nurse that has been filling in the widening cracks in Canada’s stressed health care system. Nurse practitioners work on the borders of nursing, in roles that more traditionally belong to physicians. Although they can’t provide all the medical care doctors can, they can perform much of what patients seek doctors for. A couple of years ago, the rules changed to broaden their scope further, allowing them to prescribe most medications except controlled substances (such as narcotics) and to order many diagnostic tests, says Parry, who works as a nurse practitioner at Kingston General Hospital and teaches a new generation of nurse practitioners at U of T.

In Ontario, nurse practitioners are registered nurses with two years of experience in the field who return to school for master’s nursing degrees in the nurse practitioner stream. In exchange for those extra years of schooling, nurse practitioners benefit from more career autonomy—and more money. In their starting year in Ontario, they can expect salaries of roughly $80,000, which is what many regular registered nurses can earn toward the end of their careers.

Schools such as U of T have shifted to accommodate demand. Of the 130-odd nursing master’s students admitted to the school each year, 20 per cent might have been in the nurse practitioner stream years ago, says Ann Tourangeau, associate dean of academic programs for the university’s nursing faculty. Now, nearly half the school’s nursing graduate students are hoping to become nurse practitioners.

Even as the ranks of newly minted medical professionals grow, some barriers are holding them back. Students wishing to become family doctors face long years in school, limited postgraduate training positions and the reality of hundreds of thousands of dollars of student-loan debt.

Many health care education programs face their own hurdles to growth, putting more downward pressure on the labour supply. “One of our challenges that we’re facing right now is faculty shortages,” says Tourangeau. Nursing faculty at U of T must be Ph.D.s with both clinical experience and outstanding research publications. As a result, the faculty has added only about 25 new slots for undergraduates over the past seven years, although it had roughly 900 applicants vying for 170 spots last year.

The much-publicized problem of immigrants who struggle to have their foreign credentials in medicine recognized in Canada has been a focus of government initiatives. The 2009 federal budget funded the development of a national framework to smooth foreign-credential recognition for key health care jobs, such as medical radiation technologists, pharmacists, physiotherapists, registered and licensed practical nurses, dentists and physicians.

The existence of newcomers with foreign medical training may be leading to the growth of a different kind of medical stream, however: the physician assistant, sometimes called the “physician extender.” Originating in the United States, the as-yet-unregulated profession pairs one supervising doctor with an assistant, who takes on a number of tasks, such as getting patient histories and doing select diagnostic jobs. According to national advocacy group the Canadian Association of Physician Assistants, Canada has approximately 300 physician assistants, mainly in Ontario and Manitoba, a number that’s set to grow. Roughly 160 students are now enrolled in physician assistant programs, such as McMaster University’s bachelor of health sciences (physician assistant) program—preferred by many foreign medical professionals over studying for a whole new medical degree.

For Powell, her second career as an Insite nurse is exciting. “There are no typical days there,” she says. Another bonus: It includes real, grown-up vacations—the paid kind. “As a consultant, I never had that before. It’s great to be supported that way, because nurses work really hard.”

]]>http://www.macleans.ca/work/jobs/health-care-workers-may-be-immune-to-unemployment/feed/1Halloween candies recalled because they may contain metalhttp://www.macleans.ca/general/halloween-candies-recalled-because-they-may-contain-metal/
http://www.macleans.ca/general/halloween-candies-recalled-because-they-may-contain-metal/#commentsThu, 03 Oct 2013 09:30:47 +0000The Canadian Presshttp://www2.macleans.ca/?p=428480OTTAWA – Federal health officials are warning people not to eat certain Halloween candies because they may contain harmful pieces of metal.
The Canadian Food Inspection Agency says the recall…

]]>http://www.macleans.ca/general/halloween-candies-recalled-because-they-may-contain-metal/feed/0I dropped out of McGill because of depressionhttp://www.macleans.ca/education/uniandcollege/i-dropped-out-of-mcgill-because-of-depression/
http://www.macleans.ca/education/uniandcollege/i-dropped-out-of-mcgill-because-of-depression/#commentsTue, 24 Sep 2013 13:49:45 +0000Susannah Feinsteinhttp://oncampus.macleans.ca/education/?p=58916Advice from a woman who couldn't find help on campus

I dropped out of McGill University because of depression. It was the type that begins as a barely perceptible malaise but quickly penetrates your mind and renders you nearly unable to speak, think, or even walk. Perhaps the most common misunderstanding of depression is that it’s simply an overarching sadness permeating your positive thoughts. In its most serious form, the illness may actually leave you unable to feel anything—comfort or happiness, fear or rage. It wasn’t until I’d reached this level that I finally decided to take time off from my routine and accept help. If you find any aspect of this story relatable, I hope that you seek help immediately.

I vividly remember the first (and last) time I used McGill Mental Health Services. My parents had been asking me to get in touch with someone for months. I’d always responded to these requests by saying no, I wouldn’t see anyone because I was “fine” and “therapists are for people who need attention.” But after two years of growing increasingly despondent, I knew I had to do something. So I temporarily abandoned my mask of confidence and called.

To be guaranteed an appointment, even during summer vacation, I had to call a month in advance. I got a time slot and, a month later, made my first visit to the Brown building.

After I filled out a survey, the receptionist at the Mental Health desk directed me to the office of a triage therapist, where I was greeted with a flat, “Hello, please take a seat.” She asked me why I was there, and I couldn’t articulate further than that I was “unhappy.” She asked if I’d had interpersonal problems—friendship issues, family issues, issues with a significant other, etc. To all these prompts, I responded truthfully that no, I had none. At the conclusion of our ten minute long meeting, she informed me that no, I was “not depressed”, that there was nothing she or a therapist could do for me, and that I should go to the Career Planning Service and talk to someone there. This interaction deterred me from seeking further help, as I left McGill Mental Health that day convinced that nobody would ever understand my general discontentment with life.

When school started again in the fall, I began a pathetic attempt to feign mental and emotional stability. My friends and professors had no idea that I was having personal issues, because I appeared fine. I still went to parties, and talked with friends for hours. I even comforted a few people who might have been facing depression themselves but privately I was unraveling. I started to have outbursts of anger or sadness. The second I was alone, I’d cry almost uncontrollably. I had to leave classes to cry. I had to leave conferences to cry.

But I convinced myself that I could push through it and within a few weeks of the school year I started to have vivid suicidal thoughts. I didn’t think I’d ever act on them, but thoughts of ideation consumed hours of my day—how I might do it, what I would be wearing. My mom started to call multiple times a day, just to make sure I’d pick up. I thought that I had to maintain a semblance of composure or face abandonment by friends. I began to make up excuses for leaving social gatherings. My grades plummeted. The depression grew progressively worse until one day I had to barricade myself in a closet until an overpowering wave of suicidal thoughts passed. Two days later, I walked out of my first final of the semester and with my last ounce of sanity withdrew from all my classes and left McGill.

Ignoring the first signs of depression is like ignoring a suspicious lump growing on your body. Like a tumor, depression, if left untreated, will wreak havoc on your health in virtually every respect. It will become more dangerous to you and perhaps those around you. It may well kill you. Last spring, if I hadn’t exercised an uncharacteristic level of restraint, I probably would have been a victim of depression myself.

McGill is struggling financially and McGill Mental Health Services are operating on a very limited budget. If students are guaranteed access to these services, I see no issue. The real problem with these services is that they’re incompatible with the needs of a deeply depressed person at almost every level. A triage therapist might misdiagnose you. They might see hundreds of students a week and be unconsciously eager to get you out of the office. Overcoming a bout of depression will take many appointments. It might take dozens of therapists until you even find one with whom you’re comfortable. If you’re feeling really low, you might not even have the energy or motivation to make an appointment. It’s incredibly difficult to address mental health issues at any large university, not just McGill.

As someone who’s cycled through many phases of depression, I want to give some advice. If you start to notice a negative change in your mood, go to McGill Mental Health immediately. Don’t write off uneasy feelings as nothing because you know yourself better than any triage therapist. If your negative moods begin to intensify, leave. Take a semester off. Take a year off. Transfer. Go back home or to wherever you feel safest. Reconnect with your family. Find a therapist you can talk to. If you’re willing, try antidepressants. But please, if you find yourself feeling progressively more numb or ‘empty,’ get as far away from school as you can. It might not be financially convenient, or fit with the career progression schedule you had planned, but your life is invaluable and you can always return.

I knew two people who decided to end their lives at McGill in the past year. Horrific doesn’t even begin to describe a suicide at 21 or 22. Although it may seem like a truism, life really is worth living, and things do get better. I had a tortuous couple years, but that’s not much time at all. I’m at a new university, I like what I’m studying, and I’m in a city that’s always been home to me. Although I’m certainly not ‘cured’ and my life’s far from perfect, I’m happy again. I couldn’t be any luckier that I decided to take time off of school. Be your own advocate – get help now.

]]>http://www.macleans.ca/education/uniandcollege/i-dropped-out-of-mcgill-because-of-depression/feed/24Canada’s public health agency investigates 21 cases of E. coli in four provinceshttp://www.macleans.ca/news/canada/canadas-public-health-agency-investigates-21-cases-of-e-coli-in-four-provinces/
http://www.macleans.ca/news/canada/canadas-public-health-agency-investigates-21-cases-of-e-coli-in-four-provinces/#commentsTue, 24 Sep 2013 02:30:21 +0000The Canadian Presshttp://www2.macleans.ca/?p=425919VANCOUVER – The Public Health Agency of Canada is now investigating 21 cases of E. coli in five provinces related to contaminated cheese products from a farm in British Columbia.…

VANCOUVER – The Public Health Agency of Canada is now investigating 21 cases of E. coli in five provinces related to contaminated cheese products from a farm in British Columbia.

That’s up from 14 cases on Saturday, and the agency says one case each has been reported in Manitoba, Saskatchewan and Quebec, and nine people have become ill in Alberta and in British Columbia.

The individuals got sick between mid-July and early September, and an elderly woman in B.C. has died from the bacterium linked to Gort’s Gouda Cheese Farm.

The agency is reminding people to follow proper hygiene to prevent the spread of all food-borne illness including E. coli by washing their hands before and after cooking and keeping knives, counters and cutting boards clean.

Last week, the Canadian Food Inspection Agency recalled 14 raw-milk cheese products sold online, at the farm and elsewhere between May 27 and Sept. 14.

One of the co-owners of Gort’s Gouda Cheese Farm in Salmon Arm has offered a tearful apology, saying the company is trying to get to the source of the E. coli outbreak.

]]>http://www.macleans.ca/news/canada/canadas-public-health-agency-investigates-21-cases-of-e-coli-in-four-provinces/feed/0Health warning over E. coli after one person dies and three others fall illhttp://www.macleans.ca/general/health-warning-over-e-coli-after-one-person-dies-and-others-are-sickened-2/
http://www.macleans.ca/general/health-warning-over-e-coli-after-one-person-dies-and-others-are-sickened-2/#commentsWed, 18 Sep 2013 03:47:38 +0000The Canadian Presshttp://www2.macleans.ca/?p=423731VANCOUVER – One person has died and three others have fallen ill after consuming cheese produced at a farm in Salmon Arm, B.C., that the BC Centre for Disease Control…

VANCOUVER – One person has died and three others have fallen ill after consuming cheese produced at a farm in Salmon Arm, B.C., that the BC Centre for Disease Control said is connected to an E. coli outbreak.

Medical health officer Dr. Rob Parker said that the person who died last month was a patient in the Interior Health Authority who was admitted to the hospital after showing symptoms of an E. coli infection.

The unidentified person had eaten cheese from Gort’s Gouda Cheese Farm, Parker said, and the particular strain of E. coli found that person’s test results matched the same strain that infected three other people.

“The thing we’re still investigating is how much that illness, that infection, contributed to the cause of death,” he told reporters on Tuesday.

Meanwhile, the Canadian Food Inspection Agency and the company have issued a recall of several varieties of raw milk cheese produced at the farm.

“This recall is the result of an ongoing food safety investigation initiated as a result of a recent outbreak investigation,” the CFIA said late Tuesday.

“There may be recalls of additional products as the investigation at this facility continues.”

The affected products were sold at the manufacturer’s outlet, at retail stores in Alberta and British Columbia and through the Internet from May 27 to Sept. 14, 2013, the CFIA said.

The BC Centre for Disease Control said another four cases are now being investigated for the same illness, and anyone who bought products from Gort’s Gouda Cheese Farm should get rid of the cheese immediately.

The illnesses began in July, and a majority of the people infected started showing symptoms in late August and early September.

The centre said the farm has agreed to stop shipping cheese products to the rest of the province, and to stop selling cheese to the public.

E. coli is a bacteria that can cause severe stomach cramps, diarrhea and even death.

Anyone who ate the farm’s cheese and is feeling very sick is being advised to see a doctor. (CKFR, The Canadian Press)

]]>http://www.macleans.ca/general/health-warning-over-e-coli-after-one-person-dies-and-others-are-sickened-2/feed/0Michelle Obama wants people to ‘drink up,’ as in more plain, old-fashioned, calorie-free waterhttp://www.macleans.ca/news/world/michelle-obama-wants-people-to-drink-up-as-in-more-plain-old-fashioned-calorie-free-water/
http://www.macleans.ca/news/world/michelle-obama-wants-people-to-drink-up-as-in-more-plain-old-fashioned-calorie-free-water/#commentsThu, 12 Sep 2013 19:57:39 +0000The Associated Presshttp://www2.macleans.ca/?p=422087WASHINGTON – Michelle Obama has pushed Americans to eat healthier and to exercise more. Now she says we should “drink up” too. As in plain water. And more of it.…

WASHINGTON – Michelle Obama has pushed Americans to eat healthier and to exercise more. Now she says we should “drink up” too. As in plain water. And more of it.

The first lady, who has spent several years highlighting the problem of childhood obesity, is getting behind a national campaign being announced Thursday to encourage people to drink more old-fashioned, calorie-free water. Whether it comes from a faucet, an underground spring, a rambling river or a plastic bottle, the message is: “Drink up.”

She was joining the Partnership for a Healthier America as the nonpartisan, non-profit group launches the effort from Watertown, Wis., with backing from a variety of sources, including the beverage industry, media, government and entertainers such as actress Eva Longoria. Mrs. Obama is the partnership’s honorary chairwoman.

The first lady said she has realized since beginning the childhood obesity initiative in 2010 that drinking more water is the best thing people can do for their health.

“Drink just one more glass of water a day and you can make a real difference for your health, your energy and the way you feel. So ‘drink up’ and see for yourself,” she said in a statement before the announcement.

Every bodily system depends on water, which makes up about 60 per cent of a person’s body weight, according to the Mayo Clinic. Water also is a calorie-free option for people concerned about weight control, is largely inexpensive and is available practically everywhere.

Yet despite trends showing a rise in water consumption and declines in the amount of soda people drink, Larry Soler, the partnership’s president and chief executive, says the “drink up” water campaign is needed. Health advocates blame the corn syrups and other sugars in soda for obesity.

“That’s exactly the type of impact we’re glad to be seeing, and we want to accelerate that because we still have an enormous problem in this country with rates of obesity,” Soler said.

Sam Kass, executive director of “Let’s Move,” Mrs. Obama’s anti-childhood-obesity initiative, cited federal statistics showing that about 40 per cent of adults drink fewer than four cups of water daily and that one-fourth of kids below age 19 don’t drink any plain water on any given day.

How much water a person should drink daily depends on various factors, including their health, activity level and where they live. Studies have produced varying recommendations over the years, and, in 2004, the Institute of Medicine decided against recommending a daily amount of water. The institute said the average person gets enough water every day from a mix of beverages, including caffeinated ones, and the water that exists in fruits and other foods.

Soler emphasized that the campaign is not about pushing a particular type of water, or stressing water over other beverages, although Mrs. Obama in the past has counselled people to switch from sugary soda to water and has talked about seeing improvement in her daughters’ health after making that change in their diets. The first lady also has been criticized by people who accuse her of being the nation’s food police.

“Every participating company has agreed to only encourage people to drink water, not focus on what people shouldn’t drink, not even talk about why they may feel their type of water is better than another,” Soler said. “It’s just ‘drink more water.’”

The consumer advocacy group Center for Science in the Public Interest said the message should be to drink less soda.

“Soda and other sugar drinks are one of the biggest promoters of obesity and diabetes, and advocating drinking more actual water and less sugar water is one of the most important messages that ‘Let’s Move’ could deliver,” said Michael Jacobson, the centre’s executive director.

The American Beverage Association, which represents the makers of soft drinks, sports drinks, energy drinks, juices and juice drinks, and bottled water and water beverages, supports the campaign, as does the International Bottled Water Association, among others, Soler said.